Yorkshire & the Humber Office
What is commissioning?
Paul McManus
Pharmacist Advisor
Yorkshire and the Humber Office
North of England Specialised Commissioning Group
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and Yorkshire and the Humber SCG
• The commissioning cycle
• Where do medicines fit in?
• Who are the commissioners?
• Medicines’ optimisation
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
• The commissioning cycle
• Where do medicines fit in?
• Who are the commissioners?
• Medicines’ optimisation
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Commissioning in
the NHS is the
process of ensuring
that the health and
care services
provided effectively
meet the needs of
the population
PERFORMANCE
• Support patient
choice
• Manage performance
• Seek public and
patient views
PLANNING
• Assess needs
• Review service
provisions
• Decide priorities
PROCUREMENT
• Design services
• Shape structures and supply
• Plan capacity and manage
demand
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Outputs
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Needs assessment
Service specification
Designation of service
Commissioning policies
Contractual framework - currencies/tariffs
Information
Quality measures/CQUIN
Innovation
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
• The commissioning cycle
• Where do medicines fit in?
• Who are the commissioners?
• Medicines’ optimisation
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
It depends…
• Community supply
– Funded from PCT prescribing budget
– Clinical and financial risk typically managed
through ‘formulary’/D&TC/APC/local prescribing
schemes
– Traditional role of Medicines Management (MM)
teams
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Payment by Results (PbR) is the payment system in England under which
commissioners pay healthcare providers for each patient seen or treated.
• Hospital supply /home delivery
– Funding managed as part of contractual agreement
• ‘In tariff’ – medicine costs included in contract payment to
provider
• ‘Excluded from tariff’ – medicine costs passed on to
commissioner
• Other funding arrangements – e.g. Cancer Drugs Fund (CDF)
– Clinical governance managed by provider
• Conflicts – e.g. ‘compassionate’ supplies, CDF, ex-clinical trials
– Shift in focus for MM teams to manage high-cost
medicines
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Medicines’ commissioning
• Response to PbR and ‘excluded’ high-cost
medicines
• Inappropriate introduction of new medicines
by Individual Funding Requests (IFRs)
• Local-decision making
– National Prescribing Centre
– Secretary of State directions April 2009
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Local decision-making
“You have the right to drugs
and treatments that have been recommended by NICE for use in
the NHS, if your doctor says they are clinically appropriate for
you.”
“You have the right to expect local decisions on funding of other
drugs and treatments to be made rationally following a proper
consideration of the evidence. If the local NHS decides not to
fund a drug or treatment you and your doctor feel would be right
for you, they will explain that decision to you.”
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Local decision-making
NHS standard contract 2012/13
Where a Variation would have a cost implication for the Commissioners, including for
the avoidance of doubt and without limitation, additional activity, new treatments,
drugs or technologies, then:
• the Provider shall provide a full and detailed cost and benefit analysis of the
requested or proposed Variation; and
• the Co-ordinating Commissioner shall, after consultation with the Provider, in its
absolute discretion have the right to refuse or withdraw the requested or
proposed Variation; and
• the Commissioners shall have no liability to the Provider for any costs arising from
the requested or proposed Variation should the Provider implement it other than
in accordance with this Agreement.
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Local decision-making
• Population focused
– Commissioning policies
– IFRs only for ‘exceptions’ to policies
• Aligned with commissioning cycle
• Horizon scanning
• Opportunities to link commissioning with
procurement
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
• The commissioning cycle
• Where do medicines fit in?
• Who are the commissioners?
• Medicines’ optimisation
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Who are the commissioners?
Pre-April 2013
• Primary Care Trusts
– Specialised Commissioning Groups
Post-April 2013
• Clinical commissioning groups (“GP consortia”)
• NHS Commissioning Board
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Health and Social Care Act 2012
“3B Secretary of State’s power to require Board to commission services
(1) Regulations may require the Board to arrange, to such extent as it considers necessary to meet all
reasonable requirements, for the provision as part of the health service of—
(a) dental services of a prescribed description;
(b) services or facilities for members of the armed forces or their
families;
(c) services or facilities for persons who are detained in a prison or in other accommodation of a prescribed description;
(d) such other services or facilities as may be prescribed.
(2) A service or facility may be prescribed under subsection (1)(d) only if the Secretary of State considers that it
would be appropriate for the Board (rather than clinical commissioning groups) to arrange for its provision as
part of the health service.
(3) In deciding whether it would be so appropriate, the Secretary of State
must have regard to—
(a) the number of individuals who require the provision of the service or facility;
(b) the cost of providing the service or facility;
(c) the number of persons able to provide the service or facility;
(d) the financial implications for clinical commissioning groups if they were required to arrange for the
provision of the service or facility.
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
• The commissioning cycle
• Where do medicines fit in?
• Who are the commissioners?
• Medicines’ optimisation
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
New responsibilities
• CCGs become the commissioners of some non-tariff
high cost medicines, for example:
– Anti-TNFs
– Ranibizumab
• “For CCGs, sound policies around medicines are crucial to ensuring patient
safety and good care. It also makes financial sense as £13bn of the NHS
budget goes on prescribing.”
• “CCGs wishing to ‘aggregate brain power’ should fund specialist teams or
committees covering a very large population area to evaluate and make
recommendations on new or expensive medicines and devices”
Commissioning Excellence, May 2012
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
New responsibilities
• Direct commissioning by NHS Commissioning
Board for ‘prescribed’ services
– National policies, for example for:
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Cystic fibrosis
Pulmonary hypertension
Renal replacement
Transplants
Immunoglobulins
HIV?
All cancer?
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Impact on procurement
• Procurement is a key consideration
– Home delivery
– Tenders
• Focus on total medicines’ expenditure
• Consideration of service costs
• Optimising investment in high-cost medicines
– Business planning for new medicines
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Some challenges
• Maintaining focus on medicines’ optimisation
• Working with a national commissioner
• Hackett report
– ‘gain’ sharing between providers and commissioners
• Patient access schemes and other ‘discounts’
– confidential price agreements
– impact on community pharmacy
• Value based pricing
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and
Yorkshire and the Humber SCG
Yorkshire & the Humber Office
What is commissioning?
paulmcmanus@nhs.net
North of England Specialised Commissioning Group comprises the former North East SCG, North West SCG and Yorkshire and the Humber SCG