Integrated Commissioning for Better Outcomes

Local Government Agency & NHS Clinical Commissioners | April 2018 | Integrated Commissioning for Better Outcomes: a commissioning framework 2018

Local Government Agency (LGA) and NHS Clinical Commissioners have updated Integrated Commissioning for Better Outcomes (ICBO) to better reflect the changing commissioning landscape.  The purpose of the framework is to support the general integration agenda across health and local government and promote consensus on good practice.

Although, the standards are primarily designed for use by commissioners in adult social care and the NHS, it is hoped that providers of services, people with personal budgets and other stakeholders are also engaged with locally when the standards are used to drive improvement. (Local Government Agency and NHS Clinical Commissioners)

It covers four areas:

  1. building the foundations;
  2. taking a person-centred, place-based and outcomes-focused approach;
  3. shaping provision to support people, places and populations;
  4. and continuously raising the ambition

The standards are intended:

  •  to support cross-organisational reflection and dialogue on how well integration in local commissioning arrangements are working
  • as a benchmarking diagnostic tool in critical self-assessment by system partners
  •  in a peer to peer review or peer challenge to promote sector led improvement.
    (Local Government Agency and NHS Clinical Commissioners )

It can be viewed here

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Paying for quality and outcomes: IAPT case studies

NHS England & NHS Improvement | April 2018 | Paying for quality and outcomes: IAPT case studies

To support commissioners and providers to implement a cluster-based payment approach, NHS England and NHS Improvement published Developing an outcomes-based payment approach for adult IAPT services in January 2017.

Now, NHS England  & NHS Improvement  have co-produced a series of case studies based on the experience of five clinical commissioning groups (CCGs) and NHS trusts who have developed and implemented, or are in the process of developing and implementing, an outcomes-based payment approach for IAPT (Improving Access to Psychological Therapies) services (NHS England & NHS Improvement).
The case studies are from:

  • Birmingham CrossCity CCG
  • Humber NHS Foundation Trust
  • South Staffordshire and Shropshire Healthcare NHS FT
  • South Tees CCG
  • Wakefield CGC 

Advice on using or implementing online consultation services

The Royal College of General Practitioners  has produced guidance which outlines considerations for GPs and GP practices considering using or implementing online consultation services.  It also includes advice for commissioning bodies such as Clinical Commissioning Groups in England that might be considering a system for their local population – one question being whether the system is likely to address current demand or generate new demand, and if the latter, what resources are available to meet it.

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This report comes as a growing number of services offering consultations online, most commonly via a smartphone apps, are hitting the market. Whilst many of these are private, some have developed partnerships with GP practices in order to deliver NHS care.

“The College recognises that online consultations can be beneficial for patients, and indeed many practices across the country are already implementing in some form. However, we want to ensure that they are being implemented in a way that is safe for patients, and alleviates pressures in general practice and across the NHS. We also think that online consultations should be provided in addition to traditional services, not instead of them.

Professor Martin Marshall, Vice Chair of the RCGP and author of the guidance, said “We hope this guidance will help everyone – patients, GPs, practice team members and commissioners – gain a better insight into online consultations, and, most importantly, help equip them with the information they need, so that patients are receiving high-quality, safe care, whichever way they choose to receive it (Royal College of General Practitioners).

The full report can be read here 

Guidance for CCGs on prescription for conditions that over the counter items treat

NHS England  | April 2018 | Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs 

New guidance from NHS England for Clinical Commissioning Groups (CCGs ) to take the proposed conditions for which over the counter items (OTC)  should not routinely be prescribed in primary care guidance into account in formulating local polices, and for prescribers to reflect local policies in their prescribing practice. Spending on OTC items for the year up to June 2017 was  approximately £569 million on prescriptions for medicines, which could otherwise be purchased over the counter from a pharmacy and/or other outlets such as petrol stations or supermarkets.drug-icon-2316244_1280
These prescriptions include items for a condition:

  • That is considered to be self-limiting and so does not need treatment as it will heal or be cured of its own accord;
  •  Which lends itself to self-care i.e. the person suffering does not normally need to seek medical advice and can manage the condition by purchasing OTC items directly.
    These prescriptions also include other common items:
  •  That can be purchased over the counter, sometimes at a lower cost than that which would be incurred by the NHS;
  •  For which there is little evidence of clinical effectiveness.

NHS England gives the example that for every  £1 million saved on prescriptions for OTC items could fund :

39 more community nurses; or

  •  270 more hip replacements; or
  •  66 more drug treatment courses for breast cancer; or
  •  1000 more drug treatment courses for Alzheimer’s; or
  • 1040 more cataract operations

The full guidance can be read at NHS England 

Specialised services quality dashboards

NHS England  | April 2018  | Specialised services quality dashboards

NHS England have released Specialised Services Quality Dashboards (SSQD) dashboards, they are designed to provide assurance on the quality of care by collecting information about outcomes from healthcare providers.  These providers, include NHS Trusts, NHS Foundation Trusts and independent providers that  submit data for each of the agreed measures.

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The information provided by the SSQDs is used by NHS England specialised services commissioners to understand the quality and outcomes of services and reasons for excellent performance. Healthcare providers can use the information to provide an overview of service quality compared with other providers of the same service
Each SSQD is ‘refreshed’ with up-to-date outcomes submitted from national data sources, and where necessary healthcare providers, on a quarterly basis. (NHS England)

The SSQDs are  organised by their National Programme of Care (NPoC), the individual dashboards can be accessed here  

Planning, assuring and delivering service change for patients

NHS England  | April 2018  |Planning, assuring and delivering service change for patients

NHS England has published guidance for commissioners on substantial service change. This guidance has been designed to support commissioners and providers to consider how to take forward their proposals, including effective public involvement, enabling them to reach robust decisions on change in the best interests of their patients. It also  mentions some of the key considerations for commissioners and their partners in designing service change and in reconfiguration.

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Clinical Commissioning Groups (CCGs) are under a statutory duty to have regard to this guidance. According to NHS England, by following this guidance, commissioners may reduce the risk of their service changes being referred to the Secretary of State, Independent Reconfiguration Panel or challenged by judicial review. By following the process set out below and appropriately and effectively involving local diverse communities, local authorities, key stakeholders and expert review (for example from Clinical Senates), later challenge may be avoided. (NHS England)

The full guidance can be downloaded from NHS England

Clinical commissioners response to the consultation on Facing the Facts, Shaping the Future

NHS Clinical Commissioners  | March 2018  | Response to draft health and care workforce strategy for England to 2027

NHS Clinical Commissioners has published its response to Health Education England (HEE)’s consultation on Facing the Facts, Shaping the Future – a draft health and care workforce strategy for England to 2027.  Following consultation with its members which included a survey and a member webinar and direct feedback. They report that commissioners greatest challenges when planning, developing and delivering place-based and person-centred across England are:

  • workforce shortages
  • future workforce availability,
  • resources to support staff development to work in the evolving system.
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Image source: nhscc.org

As a result they call on HEE to

  • highlight the defined role for strategic clinical leadership in the current commissioning structure in the new workforce strategy, with development support and succession planning provided nationally
  • focus efforts on areas which will be essential to the delivery of future services, to align priority with future need rather than current shortages.
  • increase the number of GPs and develop roles that can support reductions in primary care such as practice-based pharmacists, nurses, and paramedics.
  • recognise and develop the workforce strategy around the future system of health and care delivery envisioned in the Five Year Forward View

The full response is available from the NHS Clinical Commissioners website