Involvement of people with experience of mental illness in CCG commissioning

Little is known about the extent to which CCGs are involving people with experience of mental illness in the commissioning of mental health services | Rethink

Image source: Rethink

CCGs told us that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts-by-experience.

Information gathered by Rethink Mental Illness through a Freedom of Information (FOI) request, in which 196 out of 209 CCGs responded, uncovered that:

  • Only 15% of CCGs who responded told us they had used a co-production approach at least once in mental health commissioning
  • Only 1% of CCGs explicitly stated an ambition for co-production in mental health that was aligned to the vision in the Five Year Forward View for Mental Health – that co-production will be a standard approach to commissioning.
  • Only 14% of CCGs had plans to do more to involve people with experience of mental illness in their work.

Rethink Mental Illness’ research showed that there are some good examples of CCGs involving people with experience of mental illness in the design of services. CCGs told us that co-producing services has ensured focus on the day-to-day experience of people who use services.

This report recommends that bodies such as NHS England provide national leadership, advice and support for CCGs, and hold CCGs to account by establishing mechanisms to monitor progress. It also recommends that CCGs use tools such as the Rethink Mental Illness ‘Commissioners Co-production Grid’, and NSUN’s 4PIs to facilitate steps towards embedding co-production as the norm.

Full report here


Checklist For Recruiting CCG Lay Members

This checklist aims to support CCGs with recruiting lay members and provides a series of questions that can be asked to start conversations about both recruitment and succession planning | NHS Clinical Commissioners

Image course: NHSCC

Lay members bring an essential independent perspective to the clinical commissioning group (CCG) governing body – being separate to the day-to-day running of the organisation means that they can see it as it is seen from the outside. This checklist from the NHS Clinical Commissioners (NHSCC) Lay Members Network is the first in a series looking at different aspects of the lay member role. Aimed at CCG chairs, members of the CCG governing body and lay members, it provides a series of questions that can be asked to start conversations about recruitment and succession planning.


Managing from within the team

Most managers are members of the team they manage. This creates tension between the need to complete your own work and the need to manage the rest of the team | PCC


This course helps managers to balance these two roles, manage their team’s workload and delegate effectively. It takes you through how to successfully communicate at different levels within your organisation as well as how to avoid or manage conflict within your team.

Managing from Within the Team enables you to:

  • Get the balance right between doing and managing
  • Manage time well and delegate effectively
  • Be conscious of responsibility as role model to the team and what it involves
  • See how behaviour can shape the behaviour of others
  • Know when and how to offer help to team members
  • Provide help to team members without taking over

Read the full overview here

Commissioning healthcare in changing times

NHS Clinical Commissioners has published Making difficult decisions: commissioning healthcare in changing times.

This report aims to support CCGs in making decisions about prioritisation of resources and changes to local services. It sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes.

The report contains tips  from academic research and insight from those interviewed during the report, including commissioners, patient groups and NHS England. These tips are:

  • Identify opportunities for improvement and safe and cost-effective change in service provision.
  • Plan the change management process in advance.
  • Base decision-making on robust data where available.
  • Manage stakeholder perceptions through active engagement, consultation and nurturing trustworthy relationships.
  • Recognise that local community, clinician and political support is vital, and engage these interests early.
  • Develop an integrated communication and engagement strategy from the start
    Read Making Difficult Decisions.

Read the full report here

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Describing team development within a novel GP-led urgent care centre model: a qualitative study

Morton, S. et al. BMJ Open. 2016. 6:e010224


Objective: Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally these two groups do not work alongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there is little within the literature about the development of a team consisting of different healthcare professionals in a novel healthcare setting. Our aim was therefore to describe staff members’ perspectives of team development within the GP-led UCC model.

Design Open-ended semistructured interviews, analysed using thematic content analysis.

Setting: GP-led urgent care centres in two academic teaching hospitals in London.

Participants: 15 UCC staff members including six GPs, four ENPs, two receptionists and three managers.

Results: Overall participants were positive about the interprofessional team that had developed and recognised that this process had taken time. Hierarchy within the UCC setting has diminished with time, although some residual hierarchical beliefs do appear to remain. Staff appreciated interdisciplinary collaboration was likely to improve patient care. Eight key facilitating factors for the team were identified: appointment of leaders, perception of fair workload, education on roles/skill sets and development of these, shared professional understanding, interdisciplinary working, ED collaboration, clinical guidelines and social interactions.

Conclusions: A strong interprofessional team has evolved within the GP-led UCCs over time, breaking down traditional professional divides. Future implementation of UCC models should pro-actively incorporate the eight facilitating factors identified from the outset, to enable effective teams to develop more quickly.

Read the full article here

What makes a top clinical commissioning leader?

NHS Clinical Commissioners has published What makes a top clinical commissioning leader?

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This report highlights how both clinical and managerial leaders are integral to the success of a CCG, bringing different strengths to the organisation and its ability to deliver more for patients. The report sets out how current leaders can be supported, and a future generation inspired and encouraged to take up a role in commissioning.

Read the report ‘What makes a top clinical commissioning leader?’ here.

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Effectiveness of multidisciplinary team case management: difference-in-differences analysis

Stokes, J. et al. BMJ Open. 2016. 6:e010468

Objectives: To evaluate a multidisciplinary team (MDT) case management intervention, at the individual (direct effects of intervention) and practice levels (potential spillover effects).

Design: Difference-in-differences design with multiple intervention start dates, analysing hospital admissions data. In secondary analyses, we stratified individual-level results by risk score.

Setting: Single clinical commissioning group (CCG) in the UK’s National Health Service (NHS).

Participants: At the individual level, we matched 2049 intervention patients using propensity scoring one-to-one with control patients. At the practice level, 30 practices were compared using a natural experiment through staged implementation.

Intervention: Practice Integrated Care Teams (PICTs), using MDT case management of high-risk patients together with a summary record of care versus usual care.

Direct and indirect outcome measures: Primary measures of intervention effects were accident and emergency (A&E) visits; inpatient non-elective stays, 30-day re-admissions; inpatient elective stays; outpatient visits; and admissions for ambulatory care sensitive conditions. Secondary measures included inpatient length of stay; total cost of secondary care services; and patient satisfaction (at the practice level only).

Results: At the individual level, we found slight, clinically trivial increases in inpatient non-elective admissions (+0.01 admissions per patient per month; 95% CI 0.00 to 0.01. Effect size (ES): 0.02) and 30-day re-admissions (+0.00; 0.00 to 0.01. ES: 0.03). We found no indication that highest risk patients benefitted more from the intervention. At the practice level, we found a small decrease in inpatient non-elective admissions (−0.63 admissions per 1000 patients per month; −1.17 to −0.09. ES: −0.24). However, this result did not withstand a robustness check; the estimate may have absorbed some differences in underlying practice trends.

Conclusions: The intervention does not meet its primary aim, and the clinical significance and cost-effectiveness of these small practice-level effects is debatable. There is an ongoing need to develop effective ways to reduce unnecessary attendances in secondary care for the high-risk population.

Read the full article here