1. Strategic Commissioning Ian Tibbles & Neil Wilson 29 th January, 2004

2. 2 What we will cover Introducing the Commissioning Friend Developing a commissioning strategy Analysing the key issues – getting the right information Challenges for Kent & Medway

3. 3 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

4. 4 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

5. 5 Managing the Transition Purchasing 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 dominated by price WS Commissioning Patient centred Transition to Commissioner managed care pathways and waiting lists Focus on whole system and commission from a range of providers Incentivise modernisation Commissioner led process Negotiations dominated by quality, access and choice A range of contractual forms from cost & volume to managed care TransitionTransition

6. 6 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

7. 7 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

8. 8 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

9. 9 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

10. 10 Align strategy and services Vision Commissioning objectives Commissioning strategy Primary care services Ensure alignment Delivery plans Service Programmes

11. 11 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

12. 12 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

13. 13 Effective Lead 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

14. 14 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?

15. 15 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

16. 16 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