Effective commissioning is about ensuring that the right care is available in the right place, at the right time, with the effect of improving health outcomes, reducing inequalities and enhancing patient experience.
Commissioning is the process through which taxpayers’ money is invested to provide the best possible quality of care, and meet the population’s health needs, within the resources available. The focus is on first understanding the needs of the local population and then specifying and procuring services to deliver health and social care. Monitoring the quality of service provided and outcomes achieved is key.
Commissioning looks at the needs of whole groups of people. Members of the public and patients may make an invaluable contribution at each point of the commissioning cycle which moves around:
- understanding the needs of the local community
- setting priorities, developing strategies, planning for the optimum services to meet local aspirations as well as national standards
- Patient and carer engagement to improve services.
- procuring services from providers to meet local and national targets
- monitoring, assessing and, where necessary, challenging the quality of services;
Clinical Commissioning Groups
From April 2013, clinically led Clinical Commissioning Groups, made up of local member GP practices, will be taking responsibility for how the majority of the local health budget is spent in England.
CCGs are not responsible for commissioning all services, for instance the Local Area Team of the National Commissioning Board takes responsibility for commissioning general medical practices (GPs).
Clinical Commissioning Groups (CCGs) have a statutory responsibility to engage patients and the public. As part of their CCG Authorisation process, they are charged to ensure meaningful engagement with patients, carers and the communities:
“CCGs need to be able to show they will ensure inclusion of patients, carers, public, communities of interest and geography, health and wellbeing boards and local authorities. They should include mechanisms for gaining a broad range of views then analysing and acting on these. It should be evident how the views of individual patients are translated into commissioning decisions and how the voice of each practice population will be sought and acted on. CCGs need to promote shared decision-making with patients, about their care.”
GPs on the governing body of a CCG are joined by a hospital doctor, and a registered nurse. There may be other clinicians on the Board too, for example a pharmacist.
About 90% of people’s contact with the NHS is through GP practices, dental practices, community pharmacies and high street optometrists. People look to GPs to have a close understanding of the needs of their population, and day to day experiences of patients and carers as users of health services.
Informing commissioning decisions
CCGs around the country are responsible for engaging with patients and members of the public on what healthcare looks like in their community.
They are charged to put systems in place to convert insights about patient choice/s made within practice consultations into plans and decision-making, so that the views of individual patients are reflected in shared decision making and translated into commissioning decisions.
The engagement cycle tool produced by the National Institute for Innovation and Improvement has been designed to support CCGs in developing engagement strategies and plans and sets out the main reasons for engagement i.e. morale, business sense, social and political, health and legal.
Individual CCG’s are establishing conduits for engagement and involvement with patients and the public to inform their decision making including channels through which views of patients registered with member practices can be gathered and then used along with feedback from users of services which the CCG commissions, and to complement views from local members of the public. To support the modernisation of healthcare the Department of Health publishes case studies of Public and Patient Engagement in CCGs.
The business case for meaningful engagement
There are challenges ahead as public services manage within budget, and patients and the public can have a voice in how and what the NHS spends its money on.The Department of Health has compiled a set of case studies to demonstrate the potential for meaningful and effective involvement in commissioning to drive economic, quality and user experience benefits for the NHS and partner organizations, as well as for the populations they serve.
Working with the support of Commissioning Support Units
While many CCG’s will hold their Quality and Safeguarding teams in-house, and larger CCGs might well do the same with communications and engagement functions, many Groups can be expected to buy in such services from one of the country’s new Commissioning Support Units.
Promoting patient information
Some commissioning groups may choose to promote patient information as part of a long-term strategy that aims to help us create a healthier population and reduce NHS costs, for example by building approaches such as Making Every Contact Count into the contract with individual healthcare providers so that staff of services they commission are encouraged to take every opportunity to talk to individuals about improving their health and well being.
As Public Health functions moves under the auspices of the Local Authority the delivery of health promotion resources and services may change, and new opportunities and channels through which to promote health and wellbeing may emerge.
Working with HealthWatch
Also at Local Authority level, there will be a Healthwatch organisation responsible for taking the experiences that people have of local care and using these to help shape local services.
- Clinical Commissioning Group’s are responsible for engaging and involving patients and the public in commissioning decisions
- CCG’s are developing conduits through which to gather the views of patients registered with member practices and of those using services commissioned by the CCG
- Keep an eye on your CCG’s website to find out more about the approaches being used and how you can get involved
- Follow the development of your local Healthwatch
Acknowledgement: Sue Lacey-Bryant, Head of Commissioning Support and Organisational Development, Milton Keynes Clinical Commissioning Group
Page last update: 12/11/12