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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The future of commissioning

NHS Providers has launched a new publication series “Provider Voices” which promotes the views of leaders from a range of trusts and other parts of the service on some of the key issues facing the NHS.

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The first report Where next for commissioning? includes eight interviews that address concerns including the role of Sustainability and Transformation Partnerships (STPs) and accountable care systems (ACSs), the challenge of integrating health and care commissioning, and the future of the purchaser-provider split.

Related:

 

Integration and Better Care Fund Policy Framework

The Better Care Fund will provide financial support for councils and NHS organisations to jointly plan and work together to deliver local services.

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This document sets out the story of integration of health, social care and other public services, and provides an overview of related policy initiatives and legislation.

It is intended for use by those responsible for delivering the Better Care Fund at a local level (such as clinical commissioning groups, local authorities, health and wellbeing boards) and NHS England.

It includes the policy framework for the implementation of the statutory Better Care Fund in 2017 to 2019, which was first announced in the government’s Spending Review of 2013 and established in the Care Act 2014.

It also sets out proposals for going beyond the Fund towards further integration by 2020.

The Social Care Institute for Excellence’s report, Integration 2020: Scoping research, has also been published.

Full paper: Integration and Better Care Fund Policy Framework 2017 to 2019

Outcomes-focused integrated care: lessons from experience

This new paper, an update to ‘From the Ground Up’, captures some of the learning and experience from our work on developing integrated practice | IPC

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Image source: IPC

As local authorities and health organisations undergo significant periods of transformation, IPC has supported the cultural and organisational changes needed to deliver outcome-focused care, as well as operational design, from the start of the process through to implementation and evaluation.

The need to integrate care has long been a key issue and people’s understanding of what it takes to successfully implement it has evolved over time.  There has been a shift of focus from co-location and organisational structures towards working with teams to clarify and consolidate the professional roles and relationships which will make integration work in practice.

Here, we explore ‘what works’, offering guidance to those embarking on a significant period of change and integration on what they may need to consider.  It draws on IPC’s practice-based experience of integration across a range of different organisational set-ups and cultures.

Read the full report here

Primary and acute care system (PACS)

NHS England launches frameworks to increase integration of health and care services

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NHS England has published Integrated primary and acute care systems (PACS) – Describing the care model and the business model

A PACS can be defined as a population-based accountable care model, with general practice at its core. It is organised around patients’ needs and aims to improve the physical, mental and social health and wellbeing of its local population.

However, it will also include most hospital based care, as well as primary, community, mental health and social care services. By aligning the goals and incentives of hospitals with other health and care providers, it offers the potential for a radical new approach to population health.

The integrated (PACS) Framework outlines the next steps required to set up the model – including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.

This puts clinicians in the driving seat by pooling and allocating resources to areas that will have the greatest impact on the health of their local community and creates a shared responsibility towards the most vulnerable patients.