COMMISSIONING DEVELOPMENT PROGRAMME
Commissioning Development
Programme: Primary Care
Commissioning
Dr Jill Loader
PDIG , 8th November 2012
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Navigating the new world
H&W Boards
CCGs
Health Watch
Strategic
Clinical
Networks
HEE
NHS
CB
LAs
PHE
LAT
s
LETBs
CSS
LPNs
Clinical
Senates
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Health and Social Care Act
 Greater voice for patients
 Clinically led commissioning
with CCGs directly
commissioning services for
their population
 Focus on public health
 Greater accountability locally
and nationally. LAs
responsibility to join up local
services
 Streamline arms length
bodies
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Deliver NHS Outcomes Framework
Clinical Commissioning Groups
 Commission services for their local community
• elective hospital care, rehabilitation care, urgent and emergency care,
most community health services, mental health and learning disability
services
 Duty to work with NHS CB to drive up quality of primary medical
care
 GPs provider role for primary and general medical services and
LESs
NHS Commissioning Board
 Improve the health outcomes for people in England
 Directly commission primary care, prison and military health,
specialised commissioning
 Systems oversight, partnerships and relationships
 Quality improvement and clinical6 leadership and patient safety
COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
NSH CB Directorates and Matrix Working
(with patients and the public at the heart of everything we
do)
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27 NHS CB
Local Area
Teams
10 LATs
specialised
commissionin
g hubs
12 clinical
senates
https://www.wp.dh.gov.uk/commissioningb
oard/files/2012/06/lat-senates-pack.pdf
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
NHS CB 27 Local Area Teams
 CCG development and assurance
 Emergency planning, resilience and response
 Quality and Safety
 Partnerships`
 Configuration
 System oversight
 Direct commissioning - GP services, dental services, pharmacy and certain
aspects of optical services;
 10 LATs leading on specialised commissioning across England;
 smaller number of LATs carrying out the direct commissioning of other services
such as military and prison health;
 model for the commissioning of NHS public health services and interventions
still to be finalised.
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Clinical Networks and Senates
 Clinical senates will help Clinical Commissioning Groups (CCGs),
Health and Wellbeing Boards (HWBs) and the NHS CB to make the
best decisions about healthcare for the populations they represent by
providing advice and leadership at a strategic level.
 Strategic clinical networks, hosted and funded by the NHS
Commissioning Board (NHS CB), will cover conditions or patient
groups where improvements can be made through an integrated,
whole system approach. These networks will help local commissioners
of NHS care to reduce unwarranted variation in services and
encourage innovation.
• Cancer
• Cardiovascular disease (including cardiac, stroke, diabetes and renal
disease)
• Maternity and children’s services
• Mental health, dementia and neurological conditions
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Specialised commissioning
 Nationally 10 teams – same as now with a pharmacist post in each
specialised team
 Specialised commissioning teams will lead nationally on a clinical area
e.g. SEC – intestinal failure, Yorkshire and Humberside – CF
 Expect to see a cancer drugs fund team and an individual funding
request team ( for specialised services) in each region – 4
 Significant change for providers and specialised commissioning – draft
‘prescribed services’ published but not yet agreed. Sometimes a
complete clinical area eg HIV, sometimes specialised part of clinical
pathway eg renal disease
 Draft list of PBRe medicines that will be commissioned by specialised
commissioning
 Proposal that list of medicine is by drug not indication – may be used
for a non specialised indication
 Any new medicines and/or services will be commissioned nationally
and implemented locally.
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Heather Weaver,
SEC
COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Primary Care work stream of Commissioning
Development Programme
NHS Commissioning Board
Executive Non-Departmental Public Body
38,000 contracts (£12.6 billion)
Vision - exemplar commissioner
strong commissioning based on clinical
engagement and local relationships rather than
contract management, facilitation and rapid spread
of innovation/best practice
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Local Micro Commissioning System for CCGs
LETBs
(Local Education
& Training
Boards)
Health and
wellbeing
boards
Informing needs, demand,
supply in primary care
Local
professional
networks
Contractors &
Local medical
committees
Peer review, benchmarking
and development to deliver
the contract
CCGs
Local intelligence, clinical
expertise, innovation and
development of integrated
care pathways
NHS CB
LATforce
NHSCB
field
(contracting relationship
with individual practices)
Aggregation of need and
assurance of performance
NHSCB
central
Maximising performance
Implementation and
development plans to
reflect local circumstances
Strategy, policy, contract,
procedure and assurance of
achievement of outcomes
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Community Pharmacy
 NHS CB
• Commission pharmaceutical services under terms of CPCF
• Market Entry and Exit based on PNA
• Performance and quality improvement
• Complaints
• LPN role
 H&W Board
• JSNA and PNA
• Strategic plan across health and social care to meet needs of local population
 Local Authorities
• Directly commission public health services from pharmacy, supervised methadone, needle
exchange, EHC, Chlamydia screening and treatment, stop smoking etc
• Care homes
 CCGs
• Wider medicines optimisation agenda including medicines safety, support for medicine taking.
• Involve community pharmacy in care pathways.
• Potential direct commissioning of services such as access to palliative care medicines out of hours,
minor ailment services

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The proposal for Local Professional Networks has been
developed to embed clinical expertise in the operating model

Working in conjunction with the NHS CB LAT, the vision is for local professional
networks to
1.
Provide a vehicle for clinically led and clinically owned delivery of;

Quality improvement

Best outcomes for patients that reflects local need

Best use of NHS resources

Planning and designing integrated care pathways

Strategies for service planning and health improvement

Leadership and engagement
2.
Ensure clinical leadership at the heart of the local operating model
3.
The design proposals for LPNs describe those functions where clinical expertise and
leadership could add most value within local commissioning operating model
4.
Provide a system for commissioning managers and clinicians to deliver NHS CB vision
together to a common purpose
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Dentists, Optics and Pharmacy
LETBs
(Local Education
& Training
Boards)
Health and
wellbeing
boards
Informing needs, demand,
supply in primary,
community and secondary
care
Clinical
Commissionin
g Groups
Contractors &
Local rep
committees
Peer support, peer review
and benchmarking
Local professional
networks
Local intelligence, clinical
expertise, innovation and
development of integrated
care pathways
Maximising performance
NHSCB
local
Aggregation of need and
assurance of performance
NHSCB
central
Implementation and
development plans to
reflect local circumstances
Strategy, policy, contract,
procedure and assurance of
achievement of outcomes
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Local Professional Networks operating model in more detail
Provide clinical leadership and facilitate clinical
engagement at grass roots
All primary care providers
(influence, communications, roll
out, embedding)
Be a feeder mechanism into other clinical networks
Support and advise the NHSCB in the commissioning of
these services
Advise the Health and Well Being Boards
Local clinicians
(clinical expertise for ‘task and
finish’ projects, quality
improvement, pathway redesign, strategic development
and planning)
Core Clinical
Commissioning Team
(commissioning
managers, clinical
quality and network
leaders, public health)
Engage with local representative committees
Maximise performance
Local dental networks will be concerned with the whole
dental pathway and could be the commissioning vehicle
for the Board
Local pharmacy networks will be a source of advice for
the H&W Board and their duty to conduct a
pharmaceutical needs assessment (PNA) and could
add value to the NHSCB’s approach to medicines
optimisation
Local optometric networks have more to offer the local
health system than the core commissioning
responsibilities of the Board
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
Local Pharmacy Network Test Sites
East London
and the City
East Sussex
Somerset
Cheshire,
Warrington and
the Wirral
Lancashire
Dorset
Greater
Manchester
North
Yorkshire
and York
Southampton,
Hampshire,
IOW.
Portsmouth
West Yorkshire
Hertfordshire
Staffordshire
Suffolk
North East
Cambridgeshire
Cumbria
NHS South
Yorks and
Bassetlaw
Cornwall
Devon
Essex
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Where do medicines fit into NHS CB
Structures?
 Medical directorate (Domain 3 LTCs - Martin McShane)
• Chief Pharmaceutical Officer
• Deputy CPhO
 Nursing Directorate
• 3 medication safety posts transferred from NPSA
 Operations Directorate
• Specialised commissioning 1 national lead + 10 Local Area Teams with
responsibility for specialised commissioning 1 WTE pharmacy support
• LAT primary care commissioning clinical leadership team (2 WTE 8b
equivalent)
• Medicines optimisation leadership/accountable officer for CDs?
 Commissioning Development
• Dental, Pharmacy & Optical Contracts & Projects Senior Lead
• Senior Programme Manager, Community Pharmacy Contractual
Framework
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Statement from CPhO
"By now I assume you would have all seen the structure of the Operations
Directorate of the NHS CB. Like you, I am frustrated that the important role of
senior pharmaceutical expertise and leadership has yet to be fully reflected in
the structure.
As you know, the chief professional officers for allied health professions,
dentistry, healthcare science and pharmacy will be part of the senior structure
of the NHS CB, responsible for the provision of high quality professional and
clinical leadership and advice across the new health and social care system.
Let me reassure you that Operations Directorate colleagues are working
closely with us to ensure the NHS CB has access to the regional and local
leadership it will need. For example, the local professional networks
(pharmacy, dentistry, optometry) in primary care will be integral to the local
area teams of the NHS CB.”
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COMMISSIONING DEVELOPMENT PROGRAMME – WORK IN PROGRESS
What else do we know about medicines structures?
CCGs
LAs
HEE
and
LETBs
Health
Watch
• Important medicines optimisation role for local
patients. Will either directly employ medicines
teams or commission some or all services from
another CCG or a CSS - variable across England
• Commissioning public health services including
from community pharmacy
• Care homes
• H&W Board responsible for PNA
• Workforce planning, education and training for all
NHS services, whole pharmacy workforce,
• new duty of co-operation for providers of NHS
services
• Patients and public involvement and engagement
through LPN, Medicines Optimisation Networks etc
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