“Clinical Commissioners Present and
Future - how can the private sector best support their aims?”
CAPITA Conference
Church House Conference Centre
Tuesday 10 th June 2014
Dr Michael Dixon
Chair NHS Alliance
President NHS Clinical Commissioners

Commissioning that is:-
Locally sensitive
With a primary care focus
Moving services from hospital to primary care
Improving personal and local health
Based on outcomes

211 authorised CCGs (only 3 with directions) and most within budget
Clinically led
Many examples of innovation – “taking the lead”
With a representative organisation “NHS
Clinical Commissioners”

CCGs joined a party that had started without them
NHSE/CCG not yet seen as equal partnership – e.g. arbitration process
Payment by Results (National Tariff) can favour provider
Commissioning poorly integrated between specialist/hospital and primary care – e.g. cancer
CCGs becoming “financial risk sink” – e.g. specialist care/primary care/continuing care

Variable support (CSUs)
Competition law, Section 75, 25% of CCGs putting out tenders only because they think they have to
Are frontline clinicians, especially GPs, on board?
Lack of headroom and resource in general practice and primary care – diminishing share of NHS budget

8
Public Health
Social Care
GDP

CCGs as co-commissioners of primary care
(and ?specialist care)
Better Care Fund
Improving primary care – care and continuity for the frail elderly
Integrated care

General practice at scale –
Federations/Social Enterprise/Companies
Hospitals joining forces with primary care
Alliance contracts (e.g. Leicestershire)
Accountable Care Organisations

Political
Will CCGs remain at the centre of commissioning?
GPs – Independent contractors/salaried.
Increased investment in general practice
Specialists – contracts where?
Re-disorganisation?

NHS England
How will the Stevens era differ from the Nicholson era?
Will NHSE be able to stem the tide of local change initiated by CCGs and local offices working closer together.
What will be the role of NHSE when CCGs are commissioning primary, secondary and specialist services?

Commissioning/Contracting
Payment by Results becomes recommended retail price
Focus will move to improving current contracts
Tendering, when current contractor is not delivering – tendering for outcomes and integrated care – e.g. lead provider and alliance contracts
Transparent accounts/profit caps
Any qualified provider – with managed demand

Changes in Provision
Integration
Improved and extended local care and access for the frail elderly and those with long term disease
Better primary care access to diagnostics
De-medicalising health and care – self-care, improved personal health, empowering health creating communities
(e.g. social prescription)
Role of primary care and Local Authorities as main catalysts of local health

Business acumen and financial knowledge
Experience in cost efficiency
Knowledge around commissioning/contracting/bidding
Understanding of markets and consumer needs

Support
Complement
Compete

Understanding that commissioners and providers want “more for less” and will listen to anyone that helps them to achieve this
Preliminary diagnostic/makeover followed by an offering
Providing choice of a small selection of well proven/trod options/packages

Possible Areas of Involvement for Industry
Anything that reduces hospital bed days
Anything that reduces costs or improves cost efficiency
Improved diagnostics in the community
Support for self-care and improving individual and community health.
Initiatives that support improved relationship between commissioners and public and GP practices
Helping with QoF and other “must dos”

How should industry engage with the new commissioners?
Understand and identify with their aims and perspectives
Any offers need to explicitly meet the commissioner’s needs
Transparency is essential
Risk sharing, where cost efficiency is not guaranteed
Innovation is the name of the game
Recognise the dual role of clinicians as commissioners and providers

Commissioning support where required
Helping with infrastructure/management/supplies
Helping commissioners with service specification and putting out tenders - e.g. for integrated services
Helping to reconstruct in specific disease areas – e.g. mental health, dermatology and musculoskeletal services
Helping CCGs to fully involve member GP practices
Creating a method and “norm” for commissioning for outcomes and
“closer commissioning”

Providing the services that others are not offering or not offering adequately – e.g. prison services/homeless services/services for the frail elderly (where the GP practices are not stepping up to the mark)
Supporting GP practices to work “at scale” in
Federations/companies/social enterprise units
Providing headroom/leadership/time/experience and resources for GPs to do so “without tears”
Being a member/convener/lead provider of an “alliance style” contract

Enabling hospitals to develop primary care services as an integrated package
Creating an Accountable Care Organisation (including
Community Hospitals and all primary care services)
Providing support functions for provider organisations
(e.g. bulk purchasing for GP Federations)
Putting in bids as any qualified provider

“There will be no return to the old centralised command and control systems of the 1970’s”
“Successful local arrangements will be built upon, not discarded. The approach will be bottom up and developmental”.
“Each group will be required to be representative of all the GP practices within the group”.

“There will be no return to the old centralised command and control systems of the 1970’s”
“Successful local arrangements will be built upon, not discarded. The approach will be bottom up and developmental”.
“Each group will be required to be representative of all the GP practices within the group”.
The New NHS: Modern and Dependable - 2000