Strategic commissioning

CCGs in the UK should move towards strategic commissioning if the healthcare system is to embrace a move toward integrated local care, claims a new briefing from NHS Clinical Commissioners (NHSCC).

The publication brings out lessons based on evidence from the UK and health systems abroad. These are drawn from the perspectives of those implementing and developing policy around the new care models and from research of international models, primarily of high performing place-based systems of care that have developed in New Zealand, Sweden, Spain and the United States.

‘Making strategic commissioning work’ puts forward a number of recommendations aimed at easing the transition to strategic commissioning models.

  • The patient must be placed at the centre with a focus on quality – targets, payment incentives and prescriptive regulation have proved largely unsuccessful in driving system improvement and ensuring financial sustainability.
  • Clinical commissioning leadership and engagement must be retained – the evidence shows that success of population level planning is reliant on the engagement of clinicians in primary, secondary and community care, as well as the wider workforce.
  • National clarity on the ‘end state’ is essential – while local areas must lead the development of models for integrated health and care delivery, internationally, no system has been implemented without clear political consensus and a legislative framework to support it on an ongoing basis. In the UK, this could mean a national framework is needed – provided this is not too prescriptive to limit local development.

Full document: Making strategic commissioning work: Lessons from home and away

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Guidance for CCGs on items not to be routinely prescribed

NHS England has published Items which should not routinely be prescribed in primary care: guidance for CCGs.

This guidance is addressed to CCGs to support them to fulfil their duties around appropriate use of prescribing resources supporting CCGs in their decision-making, to address unwarranted variation, and to provide clear national advice to make local prescribing practices more effective.

Additional link: NHS Clinical Commissioners press release

Budget 2017: Chancellor pledges extra £2.8bn for NHS

The chancellor has announced £2.8bn of extra revenue funding for the NHS to cope with pressures between now and the end of 2019-20 | via Health Service Journal

The funding will be split over three financial years, with £335m coming this year to help cope with winter pressures. An extra £1.6bn will be made available in 2018-19, followed by £900m in 2019-20.

NHS leaders had insisted an extra £8bn was needed over this period just to maintain day to day services, while the King’s Fund, Nuffield Trust and Health Foundation agreed £4bn was needed next year alone.

The Chancellor also said the government will provide money for an NHS staff pay rise, but only if unions agree to reform the Agenda for Change contract.

See also:

 

Commissioning children’s palliative care

Commissioning children’s palliative care in England: 2017 edition | Together for Short Lives 

This report summarises responses to a Freedom of Information request sent to every CCG and upper-tier local authority in England, asking how they plan care and support for children who need palliative care and their families, and which services they commission for them.

The report found that:

  • Children’s palliative care commissioning in England is patchy and inconsistent
  • The government’s end of life care choice commitment is not being fulfilled in almost half of local areas in England
  • Most CCGs have not implemented the new clinical guidance for children who need palliative care
  • Even though many seriously ill children need care 24 hours a day, seven days a week, commissioners are failing to plan and fund this support
  • Many local authorities are failing to commission short breaks for children who  need palliative care, despite being legally obliged to do so
  • There is a postcode lottery of bereavement care across England for parents whose child has died
  • CCGs and local authorities are failing to fund voluntary sector children’s palliative care organisations – including children’s hospices
  • Too many areas still do not commission age and developmentally appropriate services for young people with life-limiting and life-threatening conditions
  • Despite significant challenges across England, there are still some examples of commissioners reporting a broad range of children’s palliative care commissioning.

The report proposes a number of recommendations in response to these findings.

Full report:  Commissioning children’s palliative care in EnglandTogether for Short Lives’ report on children’s palliative care services commissioned by NHS clinical commissioning groups (CCGs) and local authorities in England.

CCG Improvement and assessment framework

CCG Improvement and Assessment Framework 2017/18 | NHS England 

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This updated framework describes the CCG annual performance assessment and the metrics that will inform that assessment for 2017/18; it replaces the Improvement and Assessment framework (IAF) for 2016/17.  The framework is accompanied by a technical annex which provides the detail of the construction and purpose of each of the indicators in the framework.

Full document at NHS England

Accountability and performance management arrangements for CCGs

This report explores the accountability and performance management arrangements for CCGs and looks at the implications of  STPs and accountable care systems for these| The Nuffield Trust

The NHS has developed systems to hold both providers and commissioners of NHS services to account. These have arguably become more complex with the introduction  of 44 sustainability and transformation partnerships (STPs). This report from the Nuffield Trust draws on analysis and insights from the current system, and explores the challenges and opportunities presented by STPs for accountability in the NHS. It is based on 13 interviews with senior CCG leaders and NHS England policy makers which took place in September 2016.

The report also explores how commissioners and providers respond to different approaches to accountability and performance management. The report then considers the implications of this learning for the future development of STPs, accountable care organisations and accountable care systems.

Full report: A two-way street: what can CCGs teach us about accountability in STPs?

Related Nuffield Trust blog: Staying accountable: NHS leadership in hard times

Commissioning primary care services

NHS England has updated the Primary medical care policy and guidance manual to reflect the changing landscape in primary care co-commissioning.   This document provides commissioners of primary care services the context, information and tools to safely commission and contract manage primary medical care contracts.

The document is split into four sections:

Part A – Excellent Commissioning and Partnership Working

Part B – General Contract Management

Part C – When things go wrong

Part D – General