Ch,ch,changes. The next couple of months are going to see a sea change in the management of commissioning across England. The appointments to the NHS Commissioning Board (NHSCB) sectors are being made. Appointing to these four posts will allow the wave of appointments to the local offices, to be renamed as local area teams, to be made. The commissioning support services are passing through “checkpoint two” and being set up to receive large numbers of staff from PCT clusters. more…

We are working through trying to understand exactly how commissioning support (CSS) will work with Clinical Commissioning Groups (CCGs). At a recent time out the lead manager for the CSS presented on the progress being made with Greater East Midlands CSS (GEM). They highlighted the scale of work that is required with the 277 tasks in the development plan. One of the Chief Operating Officers presented the programme of work required to see through the transition from a CCG. As they pointed out, this was a transition plan—for which the work required for authorisation is a component, not the be all and end all. There is as much to do to develop the CCGs as there is to develop the CSS—and they are mutually dependent. more…

Over the last few weeks my reading and listening has made me consider whether we are at a crossroads in understanding and agreeing the purpose and nature of healthcare. Let me start with this quote from the evaluation of the 16 integrated care pilots that were supported by the Department of Health:

“Over the past 50 years healthcare systems have been focusing on strengthening acute care sectors to respond to the needs of patients suffering from life-threatening conditions such as heart attacks. Thus, healthcare systems may not be well equipped to respond to the needs of increasingly older patients suffering from multiple chronic conditions and who require a combination of regular primary care support with both predictable and unpredictable specialist care. The goals of care for those with chronic and/or disabling conditions are not to cure (as is the case for acute conditions), but to enhance functional status, minimise distressing symptoms, and prolong and enhance quality of life through secondary prevention. It is clear that these goals are less likely to be achieved through traditional approaches to care that focus on individual diseases and are based on a relationship between an individual health/social care service-user and a single health/social care professional.” more…

The political ambiguity is, mostly, resolved. Very shortly, appointments will be made to Clinical Commissioning Groups (CCGs). At the same time appointments will be made to the local arm of the NHS Commissioning Board (now to be known as the “Area”), the NHS Commissioning Board Sectors (formally known as SHA Clusters), and Commissioning Support services. What was theoretical is becoming something very tangible. more…

Monday to Friday, for weeks now, there has been a teleconference bringing together the leads from all the major organisations across Lincolnshire involved in health and social care. The ambulance and community services, acute and mental health plus adult social care, are all regularly represented. The meeting is chaired by a commissioner. The purpose is to share intelligence and efforts to support patient flow. We started this way of working last winter and it has resulted in more “jaw jaw” and less blame shifting,  as different contributors to the  system, all of whom are dedicated to patient care, appreciated the problems other organisations were struggling with and how they could help each other. more…

I sat down with a manager who has an in depth knowledge and experience of commissioning services for people with learning disabilities, as I wanted to understand why we seemed to be doing poorly on delivering health checks. It seems so simple. Practices should offer an annual health check to people with learning disabilities. There is a financial incentive—a National Directed Enhanced Service (DES) for GPs.  The objective of the health check is to address the fact that people with learning disabilities are more likely to have undetected or poorly managed health needs, contributing to earlier mortality. Reaching out in a proactive way to support and care for the vulnerable is something that I am sure the vast majority of professionals would agree is right and proper. Yet our measure of achieving an annual health check suggests it isn’t happening.

Yet, sometimes looking at a problem in depth reveals hidden barriers and complexities that give cause for thought. more…

The reforms grind on. In the stratosphere there is a lot of noise and turbulence—people arguing passionately and polemically. Meanwhile the architecture of a new system is being constructed around those of us working in the old system. People are wondering where their future lies, or if they have a future. The basic construct is becoming clearer to many of us and we are working to support its creation. This is driven by the desire to ensure that the good work done for the public and the patients in the past does not get lost in the transition between systems, and to try and secure the theoretical benefits of the new system. It is also to try and mitigate the unintended consequences, which might not be so beneficial. more…

We are now constantly discussing the transition process and the programme of work we have mapped, which we need to follow to deliver the structural changes demanded by the reforms. This sits alongside the planning process, with the plan for 2012/13 shuttling back and forth between the SHA, PCT cluster, Clinical Commissioning Groups (CCGs), various key providers and Health and Well-Being Board. Then there are the contract negotiations, which people who have been involved will know, have a degree of all-consuming intensity at this time of year. more…

I became interested in commissioning through Fundholding. Like the majority of GP practices that got involved we did so because we wanted to improve the experience and the services our patients received. We used the influence which holding a budget gave us to address quality.  For example, we improved the safety of anticoagulation management, we accessed investigations without having to send people to hospital so we could deliver more effective care, and we reduced waiting times for planned care. Fundholding made me realise that getting involved, as a doctor, in how the system was managed could improve quality for patients. The advent of PCTs drew me into the more complex and difficult agenda of large-scale change and whole-system improvement. I realised that if I didn’t want to disadvantage my own practice, because of the obvious conflict of interest I had in being able to influence funding flows across the whole system, then I needed to leave general practice and commit to commissioning. more…

The announcement last week of the design of the NHS Commissioning Board is critically important. It signals the end of the prolonged period of ambiguity which managers have experienced since the white paper was published in July 2010. For those who have been through the round robins of previous reforms there is a realisation that this time it is not about “rearranging the deckchairs.” Everyone is coming up hard against the fact that the way we have done commissioning in the past will not suffice in the future. more…