1. Healthcare Commissioning Paul Calaminus 27 th April 2016

2. How many commissioners are there? NHS England (specialist services) NHS England (with some Clinical Commissioning Group for GPs) Clinical Commissioning Groups (Defined local areas) Local Authorities (some specific services) Public Health England

3. Clinical Commissioning Groups Delegated budgets (set using an allocation formula) Responsible for commissioning healthcare to meet the needs of the local population Work as part of local systems Are led by GPs and other local clinicians.

4. What is commissioning? Purchaser/ Provider split Quality assurance Value based commissioning

5. How does it work Needs assessment (Joint Strategic Needs Assessment) Demand (As counted by healthcare systems) Capacity Payment systems

6. Block Contracts (Capitation) Paid for population healthcare Limited incentives to achieve outcomes Key Performance Indicator regime No variation in payment related to demand and activity

7. Activity based payments “Payment by results” Changes in payment based on activity and demand Can incentivise changes in behaviour

8. But… Quality improvement Access targets Healthiness vs treating illness Value for money Achieving outcomes

9. Some “truths”… Healthcare demand always outstrips the available capacity. The pressures of an aging population and the advance of technology all create increases in cost. There is less money. The difference between healthcare and social care can be very hard to define

10. And the responses… NICE Population health approaches More support to primary care Work on integration “efficiency requirements”

11. The Five Year Forward View Sets out a plan for the NHS for the five year period (2015 – 2020) Aims to create a health service more orientated around community services Aims to save £20bn at the end of the five year period

12. Sustainability and Transformation Plans Working as areas (across health and social care) Aim to address: o Gaps in quality o Gaps in access o Gaps in finances