CREATING A PATIENTLED NHS COMMISSIONING FIT WITH SYSTEM

CREATING A PATIENT-LED NHS: COMMISSIONING - FIT WITH SYSTEM REFORM Desired Outcome Patient experience Taxpayer returns Policy Drivers Choice 18 weeks Pb. R Commissioning New Service Models Contestability Relevant Enablers & Prerequisites Demand Management Market Management Balance demand/supply Manage growth Control environment Entry/accreditation process Competition policy/level playing field Exit framework

CREATING A PATIENT-LED NHS: COMMISSIONING FRAMEWORK A) Phase B) HOW AND WHO WHAT Process Service type • Setting strategy STRATEGIC COMMISSIONING • Identifying need 1 • Micro-level Hi volume Low complexity Low volume High complexity • Planning supply/managing failure Population coverage • Financial planning • Specifying services (Strategic Commissioner) • Managing demand • Procuring 2 • Contracting Large Small • Managing contract performance 3 • Settlement • Billing, invoicing and claims Practice • Monitoring activity 4 • Reporting • Monitoring outcomes • Analyzing causalities • Patient experience • Managing information • Shared Functions • Fee for service • Buyer power • Best practice sharing • Reducing costs

CREATING A PATIENT-LED NHS: COMMISSIONING WORKSTREAMS Workstream Policy Rationale Practice-based commissioning Contracting and Procurement Payment settlement & reporting Demand management Creating a commissioning market Service Specification • Promote GP • Better value for money • Minimise • Assess and • Drive out efficiencies in commissioning • Underpin new • Reduced purchasing transaction costs • Support PBC minimise risk of supplier induced demand Pb. R • Identify legitimate • Provide timely, increases in demand commissioning functions are undertaken by someone with most appropriate skills at most appropriate “level” (i. e. regional, local) engagement • Promote local innovation and service redesign • Create efficiencies in service provision • More efficient management of patients into secondary care Intention Next Steps • Improved purchasing outcomes bureaucracy accurate information on activity , volume and cost • Counterbalance to increased capacity, new incentives, reduced controls • PCTs will have arrangements in place for universal coverage of PBC by Dec 2006 • Contract • PMDU review of current policy by Aug 05 • Options appraisal • Scoping study to • Model scale and to be completed by 30/9/05 be completed by 9/9/05 extent of SID by Autumn 05 • Recommendations • Assessment of to ministers in autumn 05 measures to manage SID by autumn 05 management and administration to be organised more efficiently, possibly procurement hubs • Development of national and regional standard contacts s to ministers in autumn 05 • Further consideration will be given to the development of a system similar to PACT • Ensure • PCT functions can be provided by external agencies, partners and consortia working on their behalf contracting model • Support Demand Management countermeasures • Comprehensive service spec’s by April 06 • Scoping study of extent of market, range of services and stakeholders, entry requirements, costs, etc by Sept 05 • Assessment of existing UK and International best practice value of national program, etc by Sept 05

CPL NHS: COMMISSIONING POLICY LEADS, POLICY DEPENDENCIES AND NHS PARTNERS NLN Lead: David Nicholson SRO: Julie Taylor Programme Lead: Miles Ayling Workstream Practice-based commissioning Contracting and Procurement Payment settlement & reporting Demand management Creating a commissioning market Service Specifications Joint DH Policy Leads Primary Care Access Commercial Directorate System Reform Delivery Analytical Team Commercial Directorate System Reform Gary Belfield Helen Edwards Ken Anderson Caitlin Francis Miles Ayling/ Sarah Hall Richard Murray Keith Derbyshire Ken Anderson Caitlin Francis Miles Ayling/ Sarah Hall NATIONAL PRIMARY CARE CONTRACTING TEAM Lead: Helen Northall STOCKPORT PCT Lead: Alison Tonge (Director of Finance and Estates) NEYNL SHA Lead: CUMBRIA & LANCASHIRE SHA and GREATER MANCHESTER SHA Lead: [tbc] NORTH MANCHESTER PCT Lead: Mandy Wearn STOCKPORT PCT Lead: Alison Tonge (Director of Finance and Estates ---- NHS Partners NATIONAL PRIMARY CARE DEVELOPMENT TEAM Lead: Ruth Kennedy SHEFFIELD PCT Lead: Simon Hampton (Director of Service Improvement and Innovation) THAMES VALLEY SHA Lead: SOUTH YORKSHIRE SHA Lead: Mike Palmer Consultants Engaged PA Consulting Lead: Shera Allen PWC Lead: Simon Leary Flute Consulting Lead: John Gurnett ----- Mc. Kinsey Lead: Barrett Reumping Policy Dependencies Streamlining PCTs Pb. R Connecting for Health Streamlining ISTCs Payment by Results Connecting for Health Streamlining Payment by Results Market Management Choice Market Management

CREATING A PATIENT-LED NHS: COMMISSIONING – LIKELY SCENARIOS Likely scenarios • Service planning • Contracting • Payment Settlement • Micro-level (PBC) • Demand Management • Creating a commissioning market • • Better use of PH & Epidemiology data, market segmentation Co-ordinated by PCT Delivered by ‘Agency’, possibly bought in Accountability remains with practice/PCT • • One contract only for each Trust Procured and managed through lead PCT or procurement hub Standard model contract (similar to FTs) To include demand management measures & PSA target req’s • • Billing, invoicing & reconciliation will be automated Hosted by shared service or agency Initially secondary care but extend to all settings Underpinned by FRM • • Development of evidence based care pathways to improve the patient experience Practice level commissioning budgets for the appropriate ranges of healthcare services High quality management information to inform decisions on utilisation and service redesign • • Measure risk and pinch points Proportionate response (80/20) Likely to include mix of supply & demand side controls, linked to non payment, e. g. • • Utilisation reviews Prior approval/notification systems • PROMS • Built into contracts • • Open market to private sector No fee – shared efficiencies Entire range of commissioning function Accountability remains with practice/PCT

CREATING A PATIENT-LED NHS: COMMISSIONING – NON SPECIALISED SERVICES FUTURE MODEL MONITOR • Monitor activity • Monitor outcomes • Analyse causalities • Review patient experiences • Manage information PURCHASE • Procure • Contract • Manage contract • Bill, invoice & claims PLAN • Set strategy • Identify need • Plan finances • Manage demand • Specify services [Monitor: Health outcomes] MESO Geography 0. 5 m – 1 m Need All needs in geo population Services Procured Med/Hi complexity Monitoring whole population Procuremen t Agency Accountability Terms Central Paying Agency PCT Strategic Commissioner Delivery Activity Specific ations [monitor: contract performance] Need Strategic Commissioner Activity MICRO Geography – 2 k – 20 k Need – All needs in geo population Services Procured – Lo complexity Monitoring – practice population Accountability Practice PCT Delivery Practice/ Consortia PCT BIF Agency Practice/ Consortia + ext support?

CREATING A PATIENT-LED NHS: COMMISSIONING – KEY QUESTIONS Policy Area Key Questions Financial Regime ØAllocations methodology – will change? ØRules, conventions that National Settlement System will need to abide by ØSame for Trusts and FT’s? ØPb. R and PBC policing regimes ØWho guards and is accountable for the cash limit Payment by Results ØHow comprehensive and by when? ØHow flexible – marginal rates? ØMacro or micro - will we unbundle? Market Management ØScope/Scale of contestability ØFailure Regime Information Systems ØRoll-out of SUS, scope and reliability Social Care ØPb. R ØCare Pathways ØCo-payments

Commissioning Key Reporting Date End August 2005 A M J J A S O N D 2006 J F M A M DM workshop & Scope To. R Demand Management J J A S O N D 2007 2008 Implementation Model scale/extent of risk of SID Evaluation & review Guidance Issued Scope & tests counter measures Report to SRB/Minister Demand Management design completed Interim guidance PBC scope finalised PBC Report & rec’s First wave of enhanced PBC All PCTs with arrangements in place to offer PBC Interim guidance Contracting & Procurement ITT issued Report and Rec’s Implementation Evaluation Contracting design completed Guidance issued Payment Settlement ITT issued Guidance issued Stakeholder engagement Risk analysis Specification design Report & recommendations V 0. 01 4 th July 2005 Major Milestone: As Planned Slippage Evaluation Procurement Early adopter design complete Early adopter implementation National roll-out 2009 J F M A M J J A S O N D J F M