Strategic Commissioning

Ian Tibbles & Neil Wilson29th January, 2004

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What we will cover

• Introducing the Commissioning Friend

•Developing a commissioning strategy

•Analysing the key issues – getting the right information

•Challenges for Kent & Medway

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The context

• The agenda for PCTs has expanded enormously– You are in charge of delivering

the changes (although it may not feel like that!)

• (Whole System) Commissioning is increasingly seen as the key to achieving change

• Organisations are still relatively new and inexperienced

• Challenges include– Capacity to decide on and

deliver a wide ranging agenda– Balancing commissioning and

delivery agendas– Lack of organisational history

within and across PCTs– Everyone and everything else is

in a state of flux

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Commissioning Friend

• On the NatPaCT website• A “how to” guide for PCTs

to audit their Commissioning processes

• Downloadable PDF files with hyperlinks to key resources

• Guide includes– Research on best practice– Step by step guides on

key activities– Case studies– 12 specialist Resource

Guides• Specialist Commissioning

Guide in your packs

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Managing the TransitionPurchasing

Block contract plus shopping list

Provider led process

NHS only -focus and provision

Care pathways and waiting lists controlled

by providers

No incentives to modernise

Virtually no patient involvement

Negotiations dominatedby price

WS Commissioning

Patient centred

Transition to Commissionermanaged care pathways

and waiting lists

Focus on whole system and commission from a range of providers

Incentivise modernisation

Commissioner led process

Negotiations dominated byquality, access and choice

A range of contractual forms from cost & volume to managed care

Transition

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Where are the levers?

PCTs have 3 key levers

1. Change the model of contract

2. Extend the range and types of service provision

3. Incentivise new models of service delivery

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6 essential steps in preparation

1. Assess organisational capacity and capability

2. Establish clear business processes

3. Involve Stakeholders

4. Analyse the policy context

5. Undertake a “business” health needs analysis

6. Governance arrangements

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Strategic Commissioning

• Be in control of the Agenda– Information– Process– Outcomes

• Manage benefits and changes tightly

• Understand– The levers

• Incentivise change– Risks

• Manage them proactively– How to share the effort

• Effective Lead Commissioning• Shared central resources

– Your stakeholders• Actively manage them

• Communicate– A clear strategic story

• Linking national and local agendas

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Being strategic

• Keep it simple– Less is more– The perfect is the enemy of the

good– The Urgent and Routine need to

be managed to ensure the delivery of the important changes

• Develop a collective strategic story that– Is clear– Jargon free– Capable of being

communicated succinctly– Explains what you are doing for

the benefit of the people you serve – your key outcomes

• Tells a clear story that links the national agenda with local priorities

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Align strategy and servicesVision

Commissioning objectives

Commissioning strategy

Primary careservices

Ensurealignment

Delivery plans

Delivery plans

ServiceProgrammes

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Commissioning Radar

• Big picture comparison of your PCT against– Your peers in the Health Economy– Nationally

• How efficient are your acute trusts?

• Pattern of services you provide– Expenditure– Comparative use of acute care

• In patient & Day Case• Outpatient• Bed days

– Use of Primary Care– Efficiency index of your acute

trusts• DoH model• National reference costs• Audit Commission comparisons

• Where are the big opportunities?– To practice level

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Commissioning in Kent & Medway

• Developing effective commissioning– Need overarching priorities– Resources – what % of the budget do you

spend on commissioning against % of your management resource dedicated to it

– How do you decide what is done at PCT, Sub economy and StHA levels?

– Is there effective shared learning of best practice across PCTs?

• Lead Commissioning– Clear rules of engagement?– Risk sharing agreement?– Maximising capacity and capability?

• Are lead commissioners given adequate resources?

• Specialist Commissioning– Realistic targets– Managing demand– Real collaboration– Resourcing the effort– Governance arrangements

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EffectiveLead Commissioning

• Be clear about:– The rights and

responsibilities of the Lead Commissioner

– The rights and responsibilities of other PCTs

– Resourcing of the commissioning process

– Communication processes to keep other PCTs informed

– How you manage changes to the agreed starting point

– Trigger mechanisms that alert other PCTs when they need to be involved in the decision-making process

– Review points• Essential to have formal

written agreement signed up to by all the PCTs

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Specialist Commissioning

• Importance of realistic targets

• Essential to manage demand– Danger of willing the ends

without the means• Signed accountability

agreement needed• Need to develop aformal

risk sharing agreement• Needs joint effort between

PCTs and StHA to achieve effective change– Are commissioning resources

sufficient to meet the expectations of the PCTs?

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Challenges to working

across PCTs• Experience suggests:

– It is important to understand• What binds us together and • What pulls us apart

– Need for clarity about why we need to work together

• How do we decide what we do as a whole system, as sub systems or as individual PCTs?

– Trust takes time to build• Especially when

– Organisations bear different risks and challenges

– They are trying to build their individual identities

– Leaders are not used to being part of a team

• Managing the process from problem identification through to developing, choosing and implementing solutions can be very problematic

• Fit for purpose processes and constant review are critical

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Leading versus Managing

• Leadership is about– Clarity of Vision– The ability to communicate

and motivate others to deliver it

– Constantly steering and refreshing the vision

• Listening to your stakeholders

• Preserving the important from the pressures of the urgent and routine

• Management is about delivery

• This group will enable not deliver– It needs clear and explicit

links to others to make things happen