1. Anthony Kealy Policy Directorate Commissioning Team Developing Commissioning Policy

2. Issues Context of NHS reforms The current position Commissioning policy framework Update on key work streams Project plan Engagement and communication

3. Context of Reforms Health Reform in England: update and next steps NHS System Rules for 2006/07 Practice Based Commissioning Guidance Commissioning Policy Framework Dec 05 Jan 06 Jul 06

4. Framework for the Reforms Better care Better patient experience Better value for money More choice & stronger voice for patients (Demand-side reforms) More diverse providers with freedom to innovate & improve (Supply-side reforms) Money following the patient, rewarding & incentivising providers (Transactional reforms) Framework of system management, regulation and decision-making (System management reforms)

5. The Current Position Practice Based Commissioning rolling out Universal coverage of PBC by December 2006 Payment by Results in place Review of specialised services commissioning Joint commissioning review

6. Commissioning Policy Framework A comprehensive policy framework and implementation guidance covering: –The range of commissioning functions –Practice based commissioning –Specialised services –Joint commissioning –Rules of engagement –National / Regional infrastructure –Potential role of private sector

7. Key Work Streams Three consultancy reports submitted: –Improving Purchasing of Clinical Services, Price Waterhouse Coopers –National Settlement System & Financial Resource Management System, Flute Consulting Ltd –Creating a Market for Commissioning Services, McKinsey

8. Improving Purchasing of Clinical Services Regional Purchasing Centres, aligned with SHAs PCTs will hold a single contract with their PC Agreements and reconciliation arrangements between PCs to cover choice and specialist out-of-region commissioning PCs work through National Settlement System

9. NSS and FRMS NSS – a single national payments engine Will aggregate all activity transactions and reimburse providers, operating on a weekly payment run Development / procurement now progressing FRMS – tool to understand financial performance and model impact of commissioning decisions PCTs would choose accredited provider Work to be taken forward through commissioning project

10. Creating a Market for Commissioning Services Need for stronger technical commissioning skills: eg financial discipline, negotiating, contracting, actuarial Could support payment/settlement, data analysis and disease management programmes A range of business models from full-service to individual service lines Action would be required to create a sustainable market Work to be taken forward through commissioning project

11. Commissioning Project Plan Define Commissioning and describe requirements for each of its component functions Develop guidance/rules on key policy elements: –Practice-based commissioning –Specialised services commissioning –Joint commissioning Identify case studies of innovative approaches and good practice Develop a framework of incentives, levers and sanctions for effective commissioning at all levels

12. Commissioning Project Plan Develop infrastructure to minimise bureaucracy and transaction costs, eg: –NSS and FRMS –Regional purchasing centres? Develop/review model contracts and SLAs Identify information requirements Secure the range of skills and capabilities required for effective strategic commissioning –Link to PCT Diagnostic and development programme –Consider role of private sector

13. Engagement & Communication DH project group, involving all key stakeholders NHS reference group Engagement with other forums (like this one)