Transcript NHS & Private Sector, Dr Dixon (PPT 6 MB)

“Clinical Commissioners Present and
Future - how can the private sector best
support their aims?”
CAPITA Conference
Church House Conference Centre
Tuesday 10th June 2014
Dr Michael Dixon
Chair NHS Alliance
President NHS Clinical Commissioners
The vision
The delivery
The obstacles
Current policy
The future
The Vision
Commissioning that is:Locally sensitive
With a primary care focus
Moving services from hospital to primary care
Improving personal and local health
Based on outcomes
The Delivery
211 authorised CCGs (only 3 with directions)
and most within budget
Clinically led
Many examples of innovation – “taking the
lead”
With a representative organisation “NHS
Clinical Commissioners”
The Obstacles
CCGs joined a party that had started without them
NHSE/CCG not yet seen as equal partnership – e.g.
arbitration process
Payment by Results (National Tariff) can favour provider
Commissioning poorly integrated between
specialist/hospital and primary care – e.g. cancer
CCGs becoming “financial risk sink” – e.g. specialist
care/primary care/continuing care
The Obstacles (Contd…)
Variable support (CSUs)
Competition law, Section 75, 25% of CCGs putting
out tenders only because they think they have to
Are frontline clinicians, especially GPs, on board?
Lack of headroom and resource in general practice
and primary care – diminishing share of NHS budget
Gearing of investment across the
system
Public Health
Social Care
GDP
8
Current Developments
CCGs as co-commissioners of primary care
(and ?specialist care)
Better Care Fund
Improving primary care – care and continuity
for the frail elderly
Integrated care
Integrated Care
General practice at scale –
Federations/Social Enterprise/Companies
Hospitals joining forces with primary care
Alliance contracts (e.g. Leicestershire)
Accountable Care Organisations
The Future
Political
Will CCGs remain at the centre of
commissioning?
GPs – Independent contractors/salaried.
Increased investment in general practice
Specialists – contracts where?
Re-disorganisation?
The Future
NHS England
How will the Stevens era differ from the Nicholson
era?
Will NHSE be able to stem the tide of local change
initiated by CCGs and local offices working closer
together.
What will be the role of NHSE when CCGs are
commissioning primary, secondary and specialist
services?
The Future
Commissioning/Contracting
Payment by Results becomes recommended retail price
Focus will move to improving current contracts
Tendering, when current contractor is not delivering –
tendering for outcomes and integrated care – e.g. lead
provider and alliance contracts
Transparent accounts/profit caps
Any qualified provider – with managed demand
The Future
Changes in Provision
Integration
Improved and extended local care and access for the frail
elderly and those with long term disease
Better primary care access to diagnostics
De-medicalising health and care – self-care, improved
personal health, empowering health creating communities
(e.g. social prescription)
Role of primary care and Local Authorities as main catalysts
of local health
What can the private sector offer?
Business acumen and financial knowledge
Experience in cost efficiency
Knowledge around
commissioning/contracting/bidding
Understanding of markets and consumer needs
How should private sector interact
with the NHS?
Support
Complement
Compete
Getting Started
Understanding that commissioners and
providers want “more for less” and will listen
to anyone that helps them to achieve this
Preliminary diagnostic/makeover followed by
an offering
Providing choice of a small selection of well
proven/trod options/packages
Possible Areas of Involvement for Industry
Anything that reduces hospital bed days
Anything that reduces costs or improves cost efficiency
Improved diagnostics in the community
Support for self-care and improving individual and
community health.
Initiatives that support improved relationship between
commissioners and public and GP practices
Helping with QoF and other “must dos”
How should industry engage with the new
commissioners?
Understand and identify with their aims and perspectives
Any offers need to explicitly meet the commissioner’s
needs
Transparency is essential
Risk sharing, where cost efficiency is not guaranteed
Innovation is the name of the game
Recognise the dual role of clinicians as commissioners
and providers
Commissioning
Commissioning support where required
Helping with infrastructure/management/supplies
Helping commissioners with service specification and putting out
tenders - e.g. for integrated services
Helping to reconstruct in specific disease areas – e.g. mental health,
dermatology and musculoskeletal services
Helping CCGs to fully involve member GP practices
Creating a method and “norm” for commissioning for outcomes and
“closer commissioning”
Provision
Providing the services that others are not offering or not
offering adequately – e.g. prison services/homeless
services/services for the frail elderly (where the GP
practices are not stepping up to the mark)
Supporting GP practices to work “at scale” in
Federations/companies/social enterprise units
Providing headroom/leadership/time/experience and
resources for GPs to do so “without tears”
Being a member/convener/lead provider of an “alliance
style” contract
Provision (Cont/d…)
Enabling hospitals to develop primary care services as an
integrated package
Creating an Accountable Care Organisation (including
Community Hospitals and all primary care services)
Providing support functions for provider organisations
(e.g. bulk purchasing for GP Federations)
Putting in bids as any qualified provider
“There will be no return to the old centralised
command and control systems of the 1970’s”
“Successful local arrangements will be built upon,
not discarded. The approach will be bottom up and
developmental”.
“Each group will be required to be representative
of all the GP practices within the group”.
“There will be no return to the old centralised
command and control systems of the 1970’s”
“Successful local arrangements will be built upon,
not discarded. The approach will be bottom up and
developmental”.
“Each group will be required to be representative
of all the GP practices within the group”.
The New NHS: Modern and Dependable - 2000