Choice

18 weeks Commissioning

PbR

Po

licy D

rivers

New Service Models

Contestability

Relevant Enablers & Prerequisites

DesiredOutcome

Patient experience Taxpayer returns

Market ManagementEntry/accreditation process

Competition policy/level playing fieldExit framework

Demand ManagementBalance demand/supply

Manage growthControl environment

CREATING A PATIENT-LED NHS: COMMISSIONING - FIT WITH SYSTEM REFORM

• Micro-level

• Contracting

1

2

4

• Monitoring activity

• Monitoring outcomes

• Patient experience

• Identifying need

• Planning supply/managing failure

• Financial planning

• Specifying services

• Managing demand

ST

RA

TE

GIC

CO

MM

ISS

ION

ING

• Setting strategy

• Procuring

• Contracting

• Managing contract performance

• Billing, invoicing and claims

• Analyzing causalities

• Managing information

Phase Process Service type

Population coverage

Hi volumeLow complexity

Low volumeHigh complexity

Small Large

• Shared Functions•Fee for service• Buyer power• Best practice sharing• Reducing costs

A) WHAT B) HOW AND WHO

(Strategic Commissioner)(Strategic Commissioner)

Practice

CREATING A PATIENT-LED NHS: COMMISSIONING FRAMEWORK

• Settlement3

• Reporting

Practice-based commissioning

Contracting and Procurement

Payment settlement & reporting

Demand management

Creating a commissioning market

•Promote GP engagement

•Promote local innovation and service redesign

•Create efficiencies in service provision

•More efficient management of patients into secondary care

•Better value for money

•Reduced purchasing transaction costs

•Improved purchasing outcomes

•Minimise bureaucracy

•Support PBC and PbR

•Provide timely, accurate information on activity , volume and cost

•Assess and minimise risk of supplier induced demand

•Identify legitimate increases in demand

•Counterbalance to increased capacity, new incentives, reduced controls

•Drive out efficiencies in commissioning

•Ensure commissioning functions are undertaken by someone with most appropriate skills at most appropriate “level” (i.e. regional, local)

•PCTs will have arrangements in place for universal coverage of PBC by Dec 2006

•Contract management and administration to be organised more efficiently, possibly procurement hubs

•Development of national and regional standard contacts

•Further consideration will be given to the development of a system similar to PACT

•PCT functions can be provided by external agencies, partners and consortia working on their behalf

Workstream

PolicyRationale

CREATING A PATIENT-LED NHS: COMMISSIONING WORKSTREAMS

Intention

•PMDU review of current policy by Aug 05

•Options appraisal to be completed by 30/9/05

•Recommendations to ministers in autumn 05

•Scoping study to be completed by 9/9/05

•Recommendations to ministers in autumn 05

•Model scale and extent of SID by Autumn 05

•Assessment of measures to manage SID by autumn 05

•Scoping study of extent of market, range of services and stakeholders, entry requirements, costs, etc by Sept 05

Next Steps

Service Specification

•Underpin new contracting model

•Support Demand Management countermeasures

•Comprehensive service spec’s by April 06

•Scoping study of existing UK and International best practice

•Assessment of value of national program, etc by Sept 05

CPL NHS: COMMISSIONING POLICY LEADS, POLICY DEPENDENCIES AND NHS PARTNERS

Programme Lead: Miles Ayling

NLN Lead: David Nicholson

Workstream

Joint DHPolicy Leads

NHS Partners

Policy Dependencies

ConsultantsEngaged

Practice-based commissioning

Primary Care - Access

Gary BelfieldHelen Edwards

NATIONAL PRIMARY CARE CONTRACTING TEAMLead: Helen Northall

NATIONAL PRIMARY CARE DEVELOPMENT TEAMLead: Ruth Kennedy

Streamlining PCTsPbRConnecting for Health

PA ConsultingLead: Shera Allen

Contracting and Procurement

Commercial Directorate

Ken AndersonCaitlin Francis

STOCKPORT PCTLead: Alison Tonge (Director of Finance and Estates)

SHEFFIELD PCTLead: Simon Hampton (Director of Service Improvement and Innovation)

StreamliningISTCs

PWCLead: Simon Leary

Payment settlement & reporting

System Reform

Miles Ayling/ Sarah Hall

NEYNL SHALead:

THAMES VALLEY SHALead:

Payment by ResultsConnecting for Health

Flute ConsultingLead: John Gurnett

Demand management

Delivery Analytical Team

Richard MurrayKeith Derbyshire

CUMBRIA & LANCASHIRE SHA and GREATER MANCHESTER SHALead: [tbc]

SOUTH YORKSHIRE SHALead: Mike Palmer

StreamliningPayment by ResultsMarket ManagementChoice

-----

Creating a commissioning market

Commercial Directorate

Ken AndersonCaitlin Francis

NORTH MANCHESTER PCTLead: Mandy Wearn

Market Management

McKinseyLead: Barrett Reumping

SRO: Julie Taylor

Service Specifications

System Reform

Miles Ayling/ Sarah Hall

STOCKPORT PCTLead: Alison Tonge (Director of Finance and Estates

----

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 – LIKELY SCENARIOS

PLAN• Set strategy• Identify need• Plan finances• Manage demand• Specify services

MONITOR• Monitor activity• Monitor outcomes• Analyse causalities• Review patient experiences• Manage information

PURCHASE• Procure• Contract• Manage contract• Bill, invoice & claims

Accountability

Delivery

Accountability

Delivery

Strategic Commissioner

Practice/Consortia

PCT

Procurement Agency

Central Paying Agency

Strategic Commissioner

Practice/Consortia

Need

Specifications

+ ext support?

Practice

Terms

Activity

Activity

[Monitor: Health outcomes]

Geography 0.5m – 1mNeed All needs in geo populationServices Procured Med/Hi complexity Monitoring whole population

Geography – 2k – 20 kNeed – All needs in geo populationServices Procured – Lo complexityMonitoring – practice population

MESO

PCT

BIF

Agency

PCT

BIF

Agency

MICRO

[monitor: contract performance]

CREATING A PATIENT-LED NHS: COMMISSIONING – NON SPECIALISED SERVICES FUTURE MODEL

CREATING A PATIENT-LED NHS: COMMISSIONING – KEY QUESTIONS

Financial Regime

Payment by Results

Market Management

Information Systems

Social Care

Allocations methodology – will change?Rules, conventions that National Settlement System will need to abide bySame for Trusts and FT’s?PbR and PBC policing regimesWho guards and is accountable for the cash limit

How comprehensive and by when?How flexible – marginal rates?Macro or micro - will we unbundle?

Scope/Scale of contestabilityFailure Regime

Roll-out of SUS, scope and reliability

PbRCare PathwaysCo-payments

Policy Area Key Questions

Contracting & Procurement

PBC

Demand Management

Payment Settlement

Commissioning

Major Milestone: As PlannedV0.01 4th July 2005

Demand Management Demand Management design completeddesign completed

ImplementationImplementation

Evaluation & reviewEvaluation & review

Slippage

Guidance issued

Contracting design completed

Implementation Report and Rec’s

Report to Report to SRB/MinisterSRB/Minister

20062005OS N D J AF M M J J OA S N D J F M

20082007JJM MA A S O N D J JJF M MA A S O N D J F M

2009J A

Model scale/extent of risk Model scale/extent of risk of SIDof SID

Key Reporting DateEnd August 2005

A M J

DM workshop & Scope ToRDM workshop & Scope ToR

Report & rec’s

ITT issued

PBC scope finalisedPBC scope finalised

First wave of enhanced PBC

Guidance Issued

All PCTs with arrangements in place to offer PBC

Evaluation

ITT issued

Report & recommendations

Specification design

Stakeholder engagement

Risk analysis

Guidance issued

Early adopter design complete

Early adopter implementation

Evaluation

National roll-out

Scope & tests counter measures

Interim guidance

Interim guidance

Procurement