Clinical Commissioning June 2012

Introduction Major shift in government policy, transferring responsibility for commissioning care to GPs Ongoing political disquiet- model likely to change to involve other parties- secondary care, other health professionals, patients Improving care, saving money, transferring responsibility and /or blame?

Effective commissioning Should be based on: Improving outcomes for patients; prioritises demand over supply, innovative approaches to delivery of services Patient empowerment; promotion of shared approaches to care, keeping patients fully informed, power to shape their own healthcare, and support to care for themselves

Effective commissioning Evidence based practice ;draw on research expertise to use evidence to assess needs, design services and monitor outcome Community mobilisation ; values of public service, harnessing the power of patients to determine their own health outcome- community engagement. Integrating with public health agenda, promoting wellbeing, preventing ill health

Effective commissioning Ensuring the needs of the vulnerable, overlooked or ignored are addressed Sustainability ; commitment to the sustainable use of resources – natural environment, NHS finances and the time and spirit of staff

Clinical commissioning groups Organisations that will take on the task of commissioning Pathfinders ; current model to develop ways of making it work locally, shadowing PCT work Will need to partner with clinicians and the public, true collaborative working Major challenge for leadership- breaking down barriers between primary and secondary care

CCGs Breaking down barriers between health and social care and professionals and the public Engagement across traditional boundaries Who will do it, and what support will they get? Currently volunteers, locally elected by peers

CCGs Do they have the requisite skills? Leadership Knowledge Vision Priorities and context Negotiation skills Managing change Respect

CCGs Health needs assessment Contracting skills Financial and budgetary understanding ……..ie a major undertaking!

What support is available? New role of Associate Dean for commissioning in Surrey, Kent and Sussex Taps in to deanery support, links to university Planned commissioning development groups to tackle practical skills acquirement, understanding and knowledge, along the lines of the existing appraisal development workshops

What support is available? National support through RCGP, LMC, BMA Planned diplomas, academic modules via universities to develop commissioning skills, possible portfolio careers for GPs GP Tutor network tasked with helping everyone to understand the process- protected learning time

Grass roots GPs Why should I be interested? ALL GPs are involved in commissioning Every prescription and referral is a commissioning act It will never work without the support and understanding of grassroot GPs QOF will encourage you!

QOF and commissioning Re allocated points for and beyond 96.5 points for quality and productivity indicators Encouraging increasing efficiency in use of NHS resources Cost effective prescribing Reducing emergency admissions and hospital referrals by use of alternate pathways QIPP agenda

Competency framework for commissioning Competency model developed after interviewing GPs, educators, CCG leads, SHA, PCT, KSS deanery Ties in with RCGP portfolio, and matches many existing competencies eg community orientation

Big picture thinking Capacity to take a global approach, considering the impact of clinical, political, economic and legal issues on commissioning decisions Capacity to take long term perspective, awareness of wider strategy of CCGs Whole systems approach, political drivers, legal issues of governing bodies Impact of commissioning on stakeholders Strategic perspective-short and long term impact of CCG decisions

Clinical leadership and self awareness Capacity to understand personal working style and impact on others within and outside CCG Capacity to seek feedback to one’s approach, adapt style to fit requirements of situation Understand position within the wider NHS Understand the strengths and weaknesses of the CCG personnel, and how best to orchestrate

Engaging stakeholders, patients and the public Capacity to articulate a vision for the CCG, and to support and motivate GP, patient and public contribution Clearly communicate need for change, explaining changes, disseminating decisions to public Listens to all stakeholders, open to criticism, accept responsibility for decisions Motivated to question existing services and look for ways to improve them

Negotiating and influencing Capacity to adapt negotiation style with range of stakeholders Adopt non confrontational style to challenge the status quo Use data and evidence to persuade stakeholders- and hold others to account Effectively manage expectations and understand the position of others Ensure promises made are delivered, hold providers to account

Collaboration and partnership working Capacity to collaborate with full range of stakeholders, and listen to all perspectives Develop teams that that include stakeholders from a variety of backgrounds Communicate in a respectful but assertive manner Build trust in the organisation and encourage a no blame culture

Problem solving and knowledge management Ability to accurately analyse patterns of population data, assess strength and scale of commissioning decisions, be open to new methods of problem solving Ability to assess outcome data to evaluate healthcare- understand QIPP and quality frameworks Arrive at solutions taking budgets, policy and economic factors into account