Evidence based commissioning - now and moving forward

Anne Gray, Knowledge Officer, Arden & GEM CSU

HLG Conference September 2016

What is commissioning?

• Commissioning is the process of procuring health services.

• It is a complex process, involving the assessment and understanding of a population’s health needs, the planning of services to meet those needs and securing services on a limited budget, then monitoring the services procured.

[Faculty of Medical Leadership and Management, 2012]

What evidence do commissioners need?

• Scope need • Data analysis • Map the current

service• Proposed service

model and pathways

• Business case• Implementation/

monitoring[http://www.epilepsytoolkit.org.uk]

A “plurality” of sources

[Swan 2012]

Analysis of items in 4 Knowledge@lerts July 2016• 20 - “expert” groups (Kings Fund, Nuffield Trust)

• 13 - NHS England/DH/PHE• 10 - clinical peer groups (Royal College, Diabetes UK)

• 6 – Guidelines/standards (NICE,CQC,NHS Improvement)• 5 – Local Government Association• 3 - case studies (CCG board papers, magazines)• 1 – peer reviewed journals

Looking for the evidenceWhat the research says:• Commissioners look for themselves or rely on

colleagues, email discussion lists & alerts• NHS sources are constantly changing and confusing • Difficult to find commissioning/ management evidence

(exception – public health team)• Don’t ask the library unless they have had previous

contact• Library staff also found it difficult

[Edwards 2013, Wye 2015]

[Wye et al. 2015, Wilson 2016]

Using the evidence

A commissioning librarian

• Service model to help my customer• Searching skills to identify the plurality of

evidence• Report formats to meet the business need

Lessons learnt – Know your customer• What is business critical?• Speak the language• Understand national and local drivers• Tailored service

Rather than merely searching for relevant articles, Anne reflected on the problem areas, searched

for evidence of a range of successful interventions achieved elsewhere and provided a new measurable solutions for the CCG to adopt. This saved me time and added real value and a

new angle of approach. CCG Director

Lessons learnt – Searching Health Serv Deliv Res

Lessons learnt – Synthesis&Summary

• Highlights …with an overview but also a link so you can do into more depth if interested

• For busy people, as we all are, the snippets are great as you don’t have to wade through a whole load of words to understand what the info is about

• Having everything in one email instead of having to remember where I saw this that and the other!!!

[Ass Dir CCG]

Existing resources• For commissioners:

– Alerting services– Map of Medicine– Evidence for Success: The guide to getting evidence and using it

(Knowledge Translation Network Scotland)– Evidence Toolkit (Avon Primary Care Research Collaborative)– Commercial evidence services eg CSUs, Baysian– Embedded librarians / Library services

• For Librarians– Commissioning Handbook for Librarians – Mailing lists

Under development• Learning Zone (KfH)• Evidence analyst pilot (Avon Primary Care

Research Collaborative)• Grey literature searching (UK Health Forum)• Synthesis/summary training (KfH)

Moving forward with STP/ Carter• What can your library build on?• How can you work with other libraries?• What can you do next week?

Bibliography• Faculty of Medical Leadership and Management, 2012

http://www.nhs.uk/NHSEngland/thenhs/about/Documents/Commissioning-FINAL-2015.pdf • Epilepsy Commissioning Toolkit http://www.epilepsytoolkit.org.uk/• Swann J et al Evidence in Management Decisions (EMD) NIHR Health Services and Delivery Research

programme; 2012. http://www2.warwick.ac.uk/fac/soc/wbs/projects/emd• Gkeredakis and Roginski The need for clarity in evidence based commissioning 23 May, 2011• Wye et al. BMC Health Services Research (2015) 15:430 http://www.biomedcentral.com/1472-6963/15/430 • Wilson PM, Effects of a demand led knowledge translation service on the uptake and use of research evidence

by NHS commissioners compared with lower intensity untargeted alternatives. HS&DR - 12/5002/18 http://www.nets.nihr.ac.uk/projects/hsdr/12500218

• Edwards et al Explaining Health Managers’ Information Seeking Behaviour and Use. Final report. NIHR Service Delivery and Organisation programme; 2013) http://www.nets.nihr.ac.uk/projects/hsdr/081808243

• Evidence for Success: The guide to getting evidence and using it (Knowledge Translation Network Scotland) http://www.evaluationsupportscotland.org.uk/resources/270/

• Evidence Works (Avon Primary Care Research Collaborative) (Avon Primary Care Research Collaborative, AHSN, NIHR CLAHRC West http://www.nhsevidencetoolkit.net/

• Commissioning Handbook for Librarians (NHS Librarians) http://commissioning.libraryservices.nhs.uk/• KfH Learning Zone http://kfh.libraryservices.nhs.uk/learning-zone/specialist-and-technical-skills/