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Commissioning challenges: relationships between public health specialists and clinical
commissioners
Dr Chris Packham RCGP National Commissioning Champion
GP and DPH
What commissioning? • CCG authorisation
– Clinical focus – Patient engagement – Credible plan – Governance – Collaborative
commissioning – Leadership
• Equity and Excellence – Redesign clinical
pathways – Partnership with
hospital specialists – Responsibility for
financial decisions – LTC management – Strip out….activities
that do not benefit health
QIPP and the DH expectations • The NHS QIPP challenge: ‘David Nicholson’s 20 billion’
• improving quality: more effective services, increased productivity
and efficiency • Elements of cost reduction to fund
– Quality – Innovation – Prevention
• The scale of challenge requires transformation • NHS inflation around 4-5% (1-2% demographics 3% technology
costs)
NHS spend 1979-2010
some commissioning tasks • Do Health Needs Assessments* (and EIA*s and
HEA*s and HIAs*) • Agree the facts with the public, politicians and
stakeholders* • Design and model your plans* • Decide what to prioritise* • Communicate • Procure • Monitor* • Evaluate*
* Require specific public health science skills
Some more commissioning tasks • How do we get a whole system approach
– Social care spending to save hospital bed blocking
– Housing spend to save mental illness admissions
• Balancing what is best (NICE guidance) with what is affordable
• Rationing
• Using evidence – Heart failure (cost saving)
– Total Parenteral Nutrition complications 44% to 9%
– For every 1% fall in smoking rates in persons with established vascular disease reduces subsequent NHS utilisation by 2% over a 3 year time frame
QIPP dilemmas: local example – Health checks
• 40-74 CVD healthchecks.
• 78,000 required to find 8,000 with a CVD risk >20%
• Locally adopted a highly targeted approach
• Found 80% of the high risk group by seeing 13,000
• Estimate see 21,000 to get 93%
• SHA demand – see 78,000!
Geo-demographic profiling: Mapping smoking cessation activity by area
Example
Superimpose high need groups
spot the gaps
Example
Public health and clinical commissioning
• (good) GPs bring – Clinical reality – Safe, efficient re-
design – Patient-friendly plans – Problem-solving with
hospitals – ‘credible’ rationing
• (good) Public Health brings – Technical analysis – Population perspective – Material to allow GPs
to make decisions – Rational basis for
unpopular decisions – Wider determinants
actions – Social care link