Commissioning – a view from the frontline

Dr Robert Varnam PhD MRCGP

Clinical Lead for Primary Care & Commissioning

robert.varnam@institute.nhs.uk @robertvarnam

Commissioning for integration

If our goal is betteroutcomes & experiencefor patients …

… our focus should beon transitions, gaps &navigation …

… not justindividual episodesor services

What do CCGs have?

a) Patient focus

b) Motivation to improve integration

c) Knowledge about the problem

d) Credibility with professionals

e) Trust of the public

f) Part of the solution

A. Joined-up commissioning

B. Commissioning joined-up care

C. Providing joined-up care

Three drivers of integration

212 CCGs

Population:260,000 average (68 – 900,000)

bit.ly/Qeefx5

© NHS Institute for Innovation and Improvement, 2012

Authorisation

Pre-ApplicationPre-ApplicationPre-ApplicationPre-Application

ApplicationApplicationApplicationApplication

NHSCB NHSCB led reviewled reviewNHSCB NHSCB

led reviewled review

COMMISSIONING DEVELOPMENT PROGRAMME

WORK IN PROGRESS – STRICTLY NOT FOR FURTHER CIRCULATION

Authorisation domains

1 A strong clinical and multi-professional focus which brings real added value

2 Meaningful engagement with patients, carers and their communities

3Clear and credible plans which continue to deliver the QIPP challenge within financial resources, in line with national requirements (including outcomes) and local joint health and wellbeing strategies

4

Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities, including financial control, as well as effectively commission all the services for which they are responsible

5Collaborative arrangements for commissioning with other clinical commissioning groups, local authorities and the NHS Commissioning Board as well as the appropriate external commissioning support

6 Great leaders who individually and collectively can make a real difference

Development for Commissioners Programme

Authorisation Timetable

Development for Commissioners Programme

Key actions for CCGs

Be a positive & proactive member of the Health & Wellbeing Board

Commission joined-up pathways for complex needs Use tariff to serve patients Design incentives & disincentives for providers Develop care coordination/navigation models & services Help general practice fulfill its potential

Key actions for NHS CB

Develop measures of integration Pilot Year of Care tariff Support positive CCG & HWB development Align outcomes frameworks Ensure national & local commissioning join up

appropriately Build a system which supports CCGs’ local autonomy

A. Joined-up commissioning

B. Commissioning joined-up care

C. Providing joined-up care

Be your CCG’s best friendFree staff to collaborate &

innovateIntegrate around the patient

A. Joined-up commissioning

B. Commissioning joined-up care

C. Providing joined-up care

Sisters are doing it for themselves