Transcript Commissioning Community Services – The challenge

Commissioning Community
Services – The challenge
Michael Sobanja
23 March 2006
Payment systems
PBR – Contracts – C4H
User
side reform
Supply
side reform
Commissioning
PBC
Clinician
engagement
Patient choice
Plurality
Foundation
Trusts
Competition
Regulation
Monitor NSFs – NICE-HCC
Three broad phases to NHS Reform
Central
Direction
National
Standards
Financial
Investment
&
Support
“Constructive
Discomfort”
"District nurses, health visitors and other
staff delivering clinical services will
continue to be employed by their PCT
unless and until the PCT decides
otherwise.“
25 October 2005
What is commissioning?
Commissioning is the process which
determines how the health and the
healthcare budget is used.
Meeting the needs and/or wants of local people?
At and affordable level?
From whom?
What's the evidence base?
Integrated access to health and social care
services
Levels of Commissioning
National
Regional
PCT Associations
PCT/LA
Practice
Neighbourhood
Locality
Cluster
PCT
COMMISSIONING
Who commissions Primary care?
10
20
30
The real challenge?
To commission excellent services in the
community that are built around the patient
and to
develop and deliver effective community
based approaches to keeping people healthy
THE DILEMMAS OF COMMISSIONING
Trying to improve the experience and health of the
individual patient without micro-managing the
providers
The trade-off between the interests of individuals and
those of the wider community
Balancing national priorities with local aspirations
and flexibility
Investment in health improvement (long term
payback) versus investment in health services
(immediate gratification)
COMMISSIONING
Different components:
Equity
fair distribution of evidence-based benefits
Responsiveness
emotional consequences of decisions
Efficiency
economic considerations including costeffectiveness
Different groups will tend to prioritise these components as follows:
Commissioners
equity, efficiency, responsiveness
Patients
responsiveness, equity, efficiency
Providers
efficiency, responsiveness, equity
EFFECTIVE COMMISSIONING
A clinical and managerial dialogue informed by
patient and user views
Creating better patient/user services, pathways and
experiences
A focus on improving process and outcomes changing the fundamentals of the system
A focus on the key problems facing the health
community
A focus on health economies rather than individual
organisation
A new range of services
Traditional primary care services, such as district nursing,
midwifery, health visiting, physiotherapy and podiatry
Diagnostics and specialist outpatient services previously
delivered in hospital
Expanded walk-in services that include diagnostic tests,
screening, clinical advice, basic prescriptions and health
promotion
Additional services, such as sexual health services, treatment for
drug and substance abuse, care for asylum seekers, prison
healthcare, care for ethnic minority groups, services for care
homes
Inpatient services at a community hospital or nursing home
Mental health services including community psychiatric nursing
and counselling
Complementary medicine?
Local health information and advocacy
Pharmacy, dentistry and optometry
The New Providers
Supermarket chain Sainsbury's has announced
plans to open general practitioner services in its
branches across the country.
Foundation
trusts
GP GMS/PMS
Partnerships
Mutuals
Pharmacos
Direct Access
Services
Cardiac
Surgery
Cardiology
Clinical
Psychology
Paediatric
Diabetes
Specialist
Nurses &
Doctors
Services for
Young People
ObstetricsJoint Diabetes
Antenatal
Service
Ophthalmology
Laser & Cataract
Services
Nursing
Homes
A& E
Emergency
Medicine
Hospital
Dietetics
Community
Dietetics
Diabetes Specialist
Services
Rheumatology
Supporting
Specialist Services
On Call
Service
Diabetologists
Primary & Community
‘Continuing Care’
Medical Wards
Wards
Receptionists
and
Support
Workers
Diabetes
Specialist Team
Eye
Screening
Optometrists
Specialist
VitreoRetinal
Services
Diabetes
Specialist
Nurses
Surgical
Wards
Nephrology
Vascular &
Orthopaedic
High Risk Surgery
Foot-care
Team
Orthotists &
Footwear
Specialists
Community
Podiatry
Web Based
Services
NHS Direct
Pharmacies
Primary
Primary
Primary
Care
Primary
Care
Primary
CareCare
Primary
Care Care Community
Nurses
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Teams
Teams
Teams
Teams
TeamsTeams
Call Centres
Components of
an Integrated
Diabetes
Care
Service
Information Services of the National Health
System - Four Elements
CONTEXT – Health Services Providers
Where can I go?
common descriptions and details of services and providers within
the health system, their configurations and locations
INTENT – Standards for Health Services
Using clinical knowledge and adopting standards of care across
the health system e.g. National electronic Library for Health
What will they (we) do?
ACTIONS - Personal Health Management
electronic records, e- bookings, referrals, investigations, and
prescriptions
What did they (we) decide?
OUTCOMES - Measuring Performance of Health Services
consistent support of the clinical audit of individual care
Did it do any good?
Information for Commissioning
Understanding need and demand
Comparative performance
Capacity generation – generating a market?
Understanding the true cost base
Giving patients useful information
…
JOINED UP THINKING !
PCS Web - a groundbreaking new e-record
system that gives everyone in the primary care
team instant, online access to patients' records
- is being piloted in two PCTs in England from
next month.
For the first time in the UK, health visitors and
district nurses will have their own tailored enursing care records, based on the
internationally recognised Omaha classification
system.
Staff will be able to draw up nursing care plans
and make detailed assessments of social
aspects such as patients’ living conditions,
hygiene needs and ability to care for
themselves; areas that a traditional GP system
does not cover, but that are essential for other
staff to plan care and measure outcomes.
health
services in the home.
'I don't like it. They're queuing for
surgery on the kitchen table.
The public is in favour of shifting care
Key Challenges – what do you think
How do we specify community health
services – particularly the “ethos”?
Who do we see as the possible providers?
How do we measure the volume of services?
What is the outcome?
How can we increase investment?
How do promote inter-practice collaboration?
How do we tie it together with Local Auhtority
services?
What part should Non Execs play in
commissioning?