1. Commissioning Development Programme: Primary Care Commissioning
Dr Jill Loader
PDIG , 8th November 2012

2. Navigating the new world
Strategic Clinical Networks
H&W Boards
CCGs
Health Watch
HEE
NHS CB
LAs
PHE
LATs
LETBs
CSS
LPNs
Clinical Senates

5. Health and Social Care Act
Greater voice for patients
Clinically led commissioning with CCGs directly commissioning services for their population
Focus on public health
Greater accountability locally and nationally. LAs responsibility to join up local services
Streamline arms length bodies

6. Deliver NHS Outcomes Framework
Clinical Commissioning Groups
Commission services for their local community
elective hospital care, rehabilitation care, urgent and emergency care, most community health services, mental health and learning disability services
Duty to work with NHS CB to drive up quality of primary medical care
GPs provider role for primary and general medical services and LESs
NHS Commissioning Board
Improve the health outcomes for people in England
Directly commission primary care, prison and military health, specialised commissioning
Systems oversight, partnerships and relationships
Quality improvement and clinical leadership and patient safety
Authorise, develop and hold to account CCGs

7. NSH CB Directorates and Matrix Working (with patients and the public at the heart of everything we do)

8. 10 LATs specialised commissioning hubs
27 NHS CB Local Area Teams
10 LATs specialised commissioning hubs
12 clinical senates

9. NHS CB 27 Local Area Teams CCG development and assurance
Emergency planning, resilience and response
Quality and Safety
Partnerships`
Configuration
System oversight
Direct commissioning - GP services, dental services, pharmacy and certain aspects of optical services;
10 LATs leading on specialised commissioning across England;
smaller number of LATs carrying out the direct commissioning of other services such as military and prison health;
model for the commissioning of NHS public health services and interventions still to be finalised.

10. Clinical Networks and Senates
Clinical senates will help Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards (HWBs) and the NHS CB to make the best decisions about healthcare for the populations they represent by providing advice and leadership at a strategic level.
Strategic clinical networks, hosted and funded by the NHS Commissioning Board (NHS CB), will cover conditions or patient groups where improvements can be made through an integrated, whole system approach. These networks will help local commissioners of NHS care to reduce unwarranted variation in services and encourage innovation.
Cancer
Cardiovascular disease (including cardiac, stroke, diabetes and renal disease)
Maternity and children’s services
Mental health, dementia and neurological conditions

11. Specialised commissioning
Nationally 10 teams – same as now with a pharmacist post in each specialised team
Specialised commissioning teams will lead nationally on a clinical area e.g. SEC – intestinal failure, Yorkshire and Humberside – CF
Expect to see a cancer drugs fund team and an individual funding request team ( for specialised services) in each region – 4
Significant change for providers and specialised commissioning – draft ‘prescribed services’ published but not yet agreed. Sometimes a complete clinical area eg HIV, sometimes specialised part of clinical pathway eg renal disease
Draft list of PBRe medicines that will be commissioned by specialised commissioning
Proposal that list of medicine is by drug not indication – may be used for a non specialised indication
Any new medicines and/or services will be commissioned nationally and implemented locally.
Heather Weaver, SEC

12. Primary Care work stream of Commissioning Development Programme
NHS Commissioning Board Executive Non-Departmental Public Body
38,000 contracts (£12.6 billion)
Vision - exemplar commissioner
strong commissioning based on clinical engagement and local relationships rather than contract management, facilitation and rapid spread of innovation/best practice

13. Local Micro Commissioning System for CCGs
LETBs (Local Education & Training Boards)
Health and wellbeing boards
Local professional networks
Contractors & Local medical committees
Informing needs, demand, supply in primary care
Peer review, benchmarking and development to deliver the contract
CCGs
NHSCB field force (contracting relationship with individual practices)
NHS CB LAT
Local intelligence, clinical expertise, innovation and development of integrated care pathways
Maximising performance
NHSCB central
Implementation and development plans to reflect local circumstances
Aggregation of need and assurance of performance
Strategy, policy, contract, procedure and assurance of achievement of outcomes

14. Community Pharmacy NHS CB H&W Board Local Authorities CCGs
Commission pharmaceutical services under terms of CPCF
Market Entry and Exit based on PNA
Performance and quality improvement
Complaints
LPN role
H&W Board
JSNA and PNA
Strategic plan across health and social care to meet needs of local population
Local Authorities
Directly commission public health services from pharmacy, supervised methadone, needle exchange, EHC, Chlamydia screening and treatment, stop smoking etc
Care homes
CCGs
Wider medicines optimisation agenda including medicines safety, support for medicine taking.
Involve community pharmacy in care pathways.
Potential direct commissioning of services such as access to palliative care medicines out of hours, minor ailment services

15. The proposal for Local Professional Networks has been developed to embed clinical expertise in the operating model
Working in conjunction with the NHS CB LAT, the vision is for local professional networks to
Provide a vehicle for clinically led and clinically owned delivery of;
Quality improvement
Best outcomes for patients that reflects local need
Best use of NHS resources
Planning and designing integrated care pathways
Strategies for service planning and health improvement
Leadership and engagement
Ensure clinical leadership at the heart of the local operating model
The design proposals for LPNs describe those functions where clinical expertise and leadership could add most value within local commissioning operating model
Provide a system for commissioning managers and clinicians to deliver NHS CB vision together to a common purpose

16. Dentists, Optics and Pharmacy
LETBs (Local Education & Training Boards)
Health and wellbeing boards
Clinical Commissioning Groups
Contractors & Local rep committees
Informing needs, demand, supply in primary, community and secondary care
Peer support, peer review and benchmarking
Local professional
networks
Local intelligence, clinical expertise, innovation and development of integrated care pathways
NHSCB local
Maximising performance
NHSCB central
Implementation and development plans to reflect local circumstances
Aggregation of need and assurance of performance
Strategy, policy, contract, procedure and assurance of achievement of outcomes

17. Local Professional Networks operating model in more detail
Provide clinical leadership and facilitate clinical engagement at grass roots
Be a feeder mechanism into other clinical networks
Support and advise the NHSCB in the commissioning of these services
Advise the Health and Well Being Boards
Engage with local representative committees
Maximise performance
All primary care providers (influence, communications, roll out, embedding)
Local clinicians
(clinical expertise for ‘task and finish’ projects, quality improvement, pathway re-design, strategic development and planning)
Local dental networks will be concerned with the whole dental pathway and could be the commissioning vehicle for the Board
Local pharmacy networks will be a source of advice for the H&W Board and their duty to conduct a pharmaceutical needs assessment (PNA) and could add value to the NHSCB’s approach to medicines optimisation
Local optometric networks have more to offer the local health system than the core commissioning responsibilities of the Board
Core Clinical Commissioning Team (commissioning managers, clinical quality and network leaders, public health)

18. Local Pharmacy Network Test Sites
East London and the City
East Sussex
Cheshire, Warrington and the Wirral
Lancashire
Southampton, Hampshire, IOW. Portsmouth
West Yorkshire
North East
Cambridgeshire
Essex
Cornwall
Devon
Somerset
Dorset
Greater Manchester
North Yorkshire and York
Hertfordshire
Staffordshire
Suffolk
Cumbria
NHS South Yorks and Bassetlaw

19. Where do medicines fit into NHS CB Structures?
Medical directorate (Domain 3 LTCs - Martin McShane)
Chief Pharmaceutical Officer
Deputy CPhO
Nursing Directorate
3 medication safety posts transferred from NPSA
Operations Directorate
Specialised commissioning 1 national lead + 10 Local Area Teams with responsibility for specialised commissioning 1 WTE pharmacy support
LAT primary care commissioning clinical leadership team (2 WTE 8b equivalent)
Medicines optimisation leadership/accountable officer for CDs?
Commissioning Development
Dental, Pharmacy & Optical Contracts & Projects Senior Lead
Senior Programme Manager, Community Pharmacy Contractual Framework

20. Statement from CPhO
"By now I assume you would have all seen the structure of the Operations Directorate of the NHS CB. Like you, I am frustrated that the important role of senior pharmaceutical expertise and leadership has yet to be fully reflected in the structure. As you know, the chief professional officers for allied health professions, dentistry, healthcare science and pharmacy will be part of the senior structure of the NHS CB, responsible for the provision of high quality professional and clinical leadership and advice across the new health and social care system. Let me reassure you that Operations Directorate colleagues are working closely with us to ensure the NHS CB has access to the regional and local leadership it will need. For example, the local professional networks (pharmacy, dentistry, optometry) in primary care will be integral to the local area teams of the NHS CB.”

21. What else do we know about medicines structures?
CCGs
Important medicines optimisation role for local patients. Will either directly employ medicines teams or commission some or all services from another CCG or a CSS - variable across England
HEE and LETBs
Workforce planning, education and training for all NHS services, whole pharmacy workforce,
new duty of co-operation for providers of NHS services
LAs
Commissioning public health services including from community pharmacy
Care homes
H&W Board responsible for PNA
Health Watch
Patients and public involvement and engagement through LPN, Medicines Optimisation Networks etc