Incapacity Benefit reforms pilot The Condition Management Programme The Role of Independent Providers Eric Sharp February 2006

Use of independent Providers Seven pilot areas Models used are fully in-house, largely contracted out, and mixed Reasons for choosing these models are related to local factors Derbyshire and Essex have substantial contracted-out services Mixed models seem to be preferred by the 14 ‘new’ sites

Contracted-out models One model is for assessment to be carried out in house, and provision to be contracted out – Essex use this However, assessment can also be contracted out - Derbyshire do this Modules of service can be contracted out – these can range from exercise tuition to elements of clinical service

Independent providers can bring: Specialist knowledge Capacity and capability Enthusiasm Credibility with service users An independent perspective

Challenges for independent providers It can be difficult to recruit and manage health care professionals in a non-health organisation Long term funding may not be guaranteed The services required may fall outside the direct experience of the organisation There may be the need to share knowledge and materials with potential rivals

Challenges for commissioners Timescales are tight Usually there is no right or wrong approach, but decisions are needed Existing commissioning structures are not set up to initiate these sorts of service There is no ready-made marketplace for services

Shared Challenges The commissioner will have an outline of the services needed, but providers will have perspectives to offer Providers are competitors, but may have to work together Services have to be delivered within a cost framework Funding is time limited, and subject to review

Contracts The contract should reflect not only the type of service, but the approach to delivery – eg a groupwork contract will tend to inhibit individual interventions Contracts can reduce but not eliminate the risks for both parties Formal monitoring is not enough in itself – good dialogue and trust is essential Volume-related or block contracts each have their advantages and disadvantages

More Challenges! The project is fast moving – providers should be able to follow the specification, but make creative suggestions for change CMP needs to stay within boundaries, and not duplicate existing services The requirements may change over time in the light of experience, or external pressures But the rewards can be gratifying, in terms of customer feedback

eric.sharp@centralderby-pct.nhs.uk