Clinical Commissioning

June 2012

Introduction

Major shift in government policy, transferring responsibility for commissioning care to GPs

Ongoing political disquiet- model likely to change to involve other parties- secondary care, other health professionals, patients

Improving care , saving money, transferring responsibility and /or blame?

Effective commissioning

Should be based on:

Improving outcomes for patients; prioritises demand over supply, innovative approaches to delivery of services

Patient empowerment; promotion of shared approaches to care, keeping patients fully informed, power to shape their own healthcare, and support to care for themselves

Effective commissioning

Evidence based practice ;draw on research expertise to use evidence to assess needs, design services and monitor outcome

Community mobilisation ; values of public service, harnessing the power of patients to determine their own health outcome- community engagement. Integrating with public health agenda, promoting wellbeing, preventing ill health

Effective commissioning

Ensuring the needs of the vulnerable, overlooked or ignored are addressed

Sustainability ; commitment to the sustainable use of resources – natural environment, NHS finances and the time and spirit of staff

Clinical commissioning groups

Organisations that will take on the task of commissioningPathfinders ; current model to develop ways of making it work locally, shadowing PCT workWill need to partner with clinicians and the public, true collaborative workingMajor challenge for leadership- breaking down barriers between primary and secondary care

CCGs

Breaking down barriers between health and social care and professionals and the public

Engagement across traditional boundaries

Who will do it , and what support will they get?

Currently volunteers , locally elected by peers

CCGs

Do they have the requisite skills?LeadershipKnowledgeVisionPriorities and contextNegotiation skillsManaging changeRespect

CCGs

Health needs assessment

Contracting skills

Financial and budgetary understanding

……..ie a major undertaking!

What support is available?

New role of Associate Dean for commissioning in Surrey, Kent and Sussex

Taps in to deanery support, links to university

Planned commissioning development groups to tackle practical skills acquirement, understanding and knowledge, along the lines of the existing appraisal development workshops

What support is available?

National support through RCGP , LMC, BMA

Planned diplomas , academic modules via universities to develop commissioning skills , possible portfolio careers for GPs

GP Tutor network tasked with helping everyone to understand the process- protected learning time

Grass roots GPs

Why should I be interested?

ALL GPs are involved in commissioning

Every prescription and referral is a commissioning act

It will never work without the support and understanding of grassroot GPs

QOF will encourage you!

QOF and commissioning

Re allocated points for 2011-2012 and beyond96.5 points for quality and productivity indicatorsEncouraging increasing efficiency in use of NHS resourcesCost effective prescribingReducing emergency admissions and hospital referrals by use of alternate pathwaysQIPP agenda

Competency framework for Competency framework for commissioningcommissioning

Competency model developed after Competency model developed after interviewing GPs , educators, CCG interviewing GPs , educators, CCG leads, SHA, PCT, KSS deaneryleads, SHA, PCT, KSS deanery

Ties in with RCGP portfolio, and Ties in with RCGP portfolio, and matches many existing competencies matches many existing competencies eg community orientationeg community orientation

Big picture thinkingBig picture thinking

Capacity to take a global approach, Capacity to take a global approach, considering the impact of clinical, considering the impact of clinical, political, economic and legal issues on political, economic and legal issues on commissioning decisionscommissioning decisionsCapacity to take long term perspective , Capacity to take long term perspective , awareness of wider strategy of CCGsawareness of wider strategy of CCGsWhole systems approach, political Whole systems approach, political drivers, legal issues of governing bodiesdrivers, legal issues of governing bodiesImpact of commissioning on stakeholders Impact of commissioning on stakeholders Strategic perspective-short and long term Strategic perspective-short and long term impact of CCG decisionsimpact of CCG decisions

Clinical leadership and self Clinical leadership and self awarenessawareness

Capacity to understand personal working Capacity to understand personal working style and impact on others within and style and impact on others within and outside CCGoutside CCG

Capacity to seek feedback to oneCapacity to seek feedback to one’’s s approach, adapt style to fit requirements of approach, adapt style to fit requirements of situationsituation

Understand position within the wider NHSUnderstand position within the wider NHS

Understand the strengths and weaknesses Understand the strengths and weaknesses of the CCG personnel, and how best to of the CCG personnel, and how best to orchestrateorchestrate

Engaging stakeholders, patients Engaging stakeholders, patients and the publicand the public

Capacity to articulate a vision for the CCG, Capacity to articulate a vision for the CCG, and to support and motivate GP , patient and to support and motivate GP , patient and public contributionand public contribution

Clearly communicate need for change, Clearly communicate need for change, explaining changes, disseminating decisions explaining changes, disseminating decisions to publicto public

Listens to all stakeholders, open to criticism, Listens to all stakeholders, open to criticism, accept responsibility for decisionsaccept responsibility for decisions

Motivated to question existing services and Motivated to question existing services and look for ways to improve themlook for ways to improve them

Negotiating and influencingNegotiating and influencing

Capacity to adapt negotiation style with Capacity to adapt negotiation style with range of stakeholdersrange of stakeholdersAdopt non confrontational style to Adopt non confrontational style to challenge the status quochallenge the status quoUse data and evidence to persuade Use data and evidence to persuade stakeholders- and hold others to stakeholders- and hold others to accountaccountEffectively manage expectations and Effectively manage expectations and understand the position of othersunderstand the position of othersEnsure promises made are delivered, Ensure promises made are delivered, hold providers to accounthold providers to account

Collaboration and partnership Collaboration and partnership workingworking

Capacity to collaborate with full range of Capacity to collaborate with full range of stakeholders, and listen to all perspectivesstakeholders, and listen to all perspectives

Develop teams that that include Develop teams that that include stakeholders from a variety of backgroundsstakeholders from a variety of backgrounds

Communicate in a respectful but assertive Communicate in a respectful but assertive mannermanner

Build trust in the organisation and Build trust in the organisation and encourage a no blame cultureencourage a no blame culture

Problem solving and knowledge Problem solving and knowledge managementmanagement

Ability to accurately analyse patterns of Ability to accurately analyse patterns of population data, assess strength and population data, assess strength and scale of commissioning decisions, be scale of commissioning decisions, be open to new methods of problem solvingopen to new methods of problem solvingAbility to assess outcome data to Ability to assess outcome data to evaluate healthcare- understand QIPP evaluate healthcare- understand QIPP and quality frameworksand quality frameworksArrive at solutions taking budgets, policy Arrive at solutions taking budgets, policy and economic factors into accountand economic factors into account