Commissioning after the Health and
Social Care Act, 2012
(Commissioning = designing and buying services
based on need)
7th February 2013
Eleanor Davies
Associate Director Joint Mental Health Commissioning
Lewisham Clinical Commissioning Group and
London Borough of Lewisham
Lewisham Joint Mental Health
Commissioning
 2 jobs are moving to the Lewisham Clinical Commissioning
Group. One part funded by the Local Authority.
 c.£90m budget
 Covering:
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Adult Mental Health – for health and social care
IAPT service
NHS Specialist services (Mother & Baby, Eating Disorders etc)
NHS Forensic services (Mentally Ill Offenders)
Mental Health of Older Adults – for health and social care
Dementia services – for health and social care
Adult Mental Health Voluntary sector – for health and social care
 £4.5m health savings and £600k LA savings required from
2011/12 – 2013/14. More savings to come….
The Health and Social Care Act in a
nutshell
What does the Health and Social Care Act do?
GPs will order and buy services (carry out commissioning).
Frees up organisations to find new and better ways to provide
services.
Gives more power to patients
Gives new spotlight on public health.
Service providers and NHS staff will have to answer criticisms
It is possibly the biggest shake up of the NHS. It has the most
far-reaching changes to the NHS since it started.
Why change?
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More people are asking for treatment
The treatment costs more
Need to make the NHS better
Less money from the government.
Key changes in the law
 GPs will play lead role in organising services for
patients.
 New rules will encourage services to be more
creative.
 Patients will have a greater voice
 Public health will have a bigger role
 The NHS will have to say why patients do not get
the treatment they need, locally and nationally
 Fewer semi independent health organisations.
The new NHS commissioning system
 The focus of new commissioning system is Accountability and
Outcomes = If patients do not get the treatment they need, the
people that organised the service will have to say why.
 Clinical Commissioning Groups (CCGs) are the new statutory
(legal) bodies for most commissioning Primary Care Trusts
(PCTs) and Strategic Health Authorities (SHAs) have gone.
 The NHS Commissioning Board (NHSCB) will make sure
Clinical Commissioning Groups act in the right way. The Board
will also arrange for NHS treatment in the community and
specialised services.
 Clinical Commissioning Groups have £25 for each person in
England to spend on their organisations (we call this
commissioning support)
 Clinical Commission Groups have to decide the best way to
spend this, for example it could be spent on their staff.
What’s happening in London…
There are 32 emerging CCGs in London, who will need to demonstrate they have robust
commissioning support in place
Enfield
Barnet
Harrow
Haringey
Waltham
Forest
Hillingdon
Brent
Camden
Camden
Ealing
Islington City &
Hackney
Redbridge
Newham
Hammersmith Central London
& Fulham
Tower
Hamlets
Havering
Barking &
Dagenham
West London
Commissioning
Hounslow
Southwark
Richmond
Wandsworth
Greenwich
Lambeth
Lewisham
Bexley
Kingston
Merton
Bromley
Sutton
Croydon
Wave 1 – 3 CCGs
Wave 2 – 15 CCGs
Wave 3 – 11 CCGs
Wave 4 – 3 CCGs
8
What type of organisation is a
Commissioning Support Unit?
NHSCB
Accountability
CCG
Services
CSU
• The 2013 NHS will be different
– Clinical Commissioning Groups will be
small and light
– Commissioning Support Units will be
extremely important in getting Clinical
Commissioning Groups up and running
and to the success of the whole
commissioning system.
– Commissioning Support Services are
funded by Clinical Commissioning
Groups and by others.
– CCGs and CSUs accountable to the
NHS Commissioning Board
– 23 Clinical Support Services in England,
3 in London
Three Commissioning Support Units are taking shape
in London
North Central
and East London
North West
London
South
London
The South London Commissioning
Support Unit - Story so far
• South London Commissioning Support Unit is designed
to give the Clinical Commissioning Groups benefit of
working on a large scale to save money
• £30m+ organisation, 300 staff, all 12 Clinical
Commissioning Groups will buy core services e.g.
finance, communications, IT, HR etc
Development of South London
Clinical Commissioning Groups
• Well prepared for the change
– Progress towards authorisation to be a CCG
– Exist in shadow form ready for April 2013
– All staff employed
What’s it really like….
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Stressful!
People are applying for new jobs or their old ones
The NHS has to save £20 billion across England
Local Authorities have had their money cut
In Lewisham GPs are becoming more aware of
how to be a commissioner
 However it is difficult for GPs to change from being
a GP to commissioning/buying a service
How can the you influence the health
and social care agenda
 Tell Clinical Commissioning Groups and Health and Wellbeing
Boards what you need.
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Support commissioners in their role – not just GPs
Find gaps in the services
Share best practice
Share evidence of what works best
Give ideas on how money can be saved to improve care
Help the public to understand the changes
Help the public become more involved
Influence big decision makers