What a Specialised Commissioner Looks for in the Annual Registry Report Monique Carayol LRMT Commissioning Lead Renal Commissioning Lead NW London LSCG

Outline  The commissioning process – what we should be doing  How things work in London  What a renal commissioner wants to know (and understand!)  Benefits of the Commissioner Summary  Key areas of interest

The Commissioning Process  PLANNING - Assessing need for service - Developing strategy to meet priorities  PROCUREMENT - Purchasing services within available resources  PERFORMANCE MONITORING - Monitoring quality and cost effectiveness of services - Identifying needs for service improvement /development

World Class Commissioning  ‘ WCC will deliver better health and well-being for all’ (DoH 2008)  The WCC agenda sets out expectations for PCTs in how to operate as exemplar commissioning organisations  Investment decisions will be made in an informed and considered way, ensuring that improvements are delivered within available resources

Carter Report  powerful and effective commissioners with authority, credibility and expertise (independent analysis of information)

Renal Commissioning Framework in London  Part of London SCG – planning and monitoring element via LRMT  5 Collaborative Commissioning Groups (CCGs) in London (also known as Local SCGs)  Differing levels of Networks in CCGs  Dialysis and transplantation services paid for on a local basis

What do commissioners want to know?  Is there equity of access?  Efficiency and quality of service provided  Estimating impact of investments  Comparison of PCT / CCG/SCG performance against national baselines

What am I Interested in right now?  Implementation of the NSF – are we making progress?  Is there real patient choice?  Pre-dialysis service provision  Vascular access  Patient transport  Implications of Organ Donation Taskforce Report

What we tried in London  NSF Performance Improvement Template launched Oct 2006  Focussed on quantitative data collection for standards 2, 3 and 4 of NSF part 1  Linked in recommendations from Pan Thames Pre-Dialysis Audit  No data collected yet!

Why was the Commissioner Summary Developed? ‘An appreciation of commissioners’ need for clear information to drive up the quality and cost effectiveness of the renal services they commission.’ RR Report 2006

Benefits of The Commissioner Summary  Much easier to understand – better use of my time!  Initial snapshot as how our local Units are performing  Supports development of service improvement plans in partnership with Units  Builds confidence in handling the data because it explains what it is showing you

Areas of Interest - Assessing Needs  New patients starting RRT (take on rate) which factors in ethnicity and age variations  Prevalence rates  Patient survival rates

Patient Choice/Equity of Access  Proportion of patients on different modalities including Home HD  % of dialysis patients on transplant lists  Patients presenting late – ‘late referrals’

Quality and Efficiency  Direct conclusions should not be drawn from this data – any variations shown should be used as an indicator for further discussion  Urea Reduction Ratio – adequacy of dialysis  % of patients commencing on dialysis with functioning permanent access  Patient survival rates

Data Returns  NSF requirement that all Units submit RR data  Can commissioners ensure that this happens?  Completeness of data returns

Conclusion  RR Commissioner Summary is a very useful tool  Can support commissioners to make informed investment decisions and to develop a better understanding for future service planning