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