Commissioning for Mental Health

By Dr Celia Grummitt

Wiltshire Clinical Commissioning Group

Background

GP Provider

GP Mental Health Commissioning Lead

A few other CCG roles…….

Co Chair SW Armed Forces Network

Veteran

Involved even in PBC days

The exam question

The colloquium is intended to explore current service provision for veterans and serving personnel illustrating areas of good practice, the commissioning of services and the future challenges

Commissioning of services required for the local population, serving personnel and veterans.

The NHS before the reforms

NHS April 2013 onwards

And it Continues to Change

And there’s an election coming

And CCG s are going to start commissioning part of primary care

And Army rebasing

The Art of Commissioning

Nil new about the process of commissioning, its like anything else……

Where are we now, where are we going and how shall we get there?

And physical health and mental health differ only through PBR

How could innovative thinking improve things? What would make that future proof?

How much would it cost above what is currently funded?

What ROI would you expect?

Where would/could funds come from?

What do you want to buy to fill the gap and how will you afford it

What levers are there?

Military Covenant

Public opinion and politics, forever changing, national and local

Finance

Lead Commissioners Good for saving resource but bad for localisation which helps meet

the needs specific to an area

Contractmanagement

Often included in commissioning which is technically incorrect but it is a sub function

Contracts are often managed on behalf of commissioners by another organisation eg the Commissioning Support Unit but more and more CCGs are taking the function back.

The “Old Way” was to help the Providers deliver, perhaps a little too much. Finding a balance is hard. Balance is needed to avoid disruption, a poorly performing provider might be better if helped and might be better than no provider. A commissioning cycle now costs a huge amount.

Procurement Law and the age of the Pilot!

Commissioning plans, intentions, approval and funding

And the long road through committees:

In Wiltshire

Localities ( about pop base 40 000),

the exec of the 3 sub groups ( covers about 140,000- 175,000)

Clinical Executive of the CCG

Governing Body of the CCG

the Joint Commissioning Board of the CCG ( services commissioned jointly with the Council

Oversight and Scrutiny Board

Health and Well being board

Know the funding streams

Primary CarePartly paid for by Area Team, partly by CCG

includes IAPT

Provides to:Veterans, reservists and families

Secondary Care Commissioned and paid for by CCG

Provides to:Veterans, reservists and families

Tertiary Care Commissioned and paid for by Area Team

Provides to:Serving personnel, veterans,

reservists and families

80% of mental health work is done in the surgery

Psychiatry outpatients

and inpatients

Very small numbers

Working together

Wiltshire’s Future Health and Care Model Mental HealthEMBED MENTAL HEALTH IN THESTRATEGY

Managing Ill-healthEstablishing and

sustaining wellness and independence

The future

“There is no money”

Veterans and reservists should use main stream, mental health services wherever possible, GP s, CMHTs etc

Veterans and reservists need the ability to talk to specially trained staff when needed, just like any other minority population which has its own cultural needs

Services are needed that reach and engage the marginalised who don’t access main stream mental health

The activity levels will grow before they go

Ensure these services are commissioned by the CCG and not forgotten