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What now for commissioning?

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Blog headlines

  • So much more than an extra pair of hands
    14 January 2021

    The introduction of the additional roles reimbursement scheme for primary care networks has started to grow capacity in general practice to address the unsustainably high workload that has put so much pressure on GPs.

  • Primary Care Networks – how did we get here?
    7 January 2021

    This week we are sharing a blog by PCC’s chairman David Colin-Thomé.

  • A year like no other
    17 December 2020

    On 5 July 1948 the NHS was born, over the last 72 years challenges and changes have been remarkable but the service has probably never been tested as much as in the last nine months. There have previously been numerous re-organisations, multiple changes to hospitals, mental health services and a shift from the family doctor towards more integrated primary care services delivered by a range of professionals. However, rapid transformation of services to embrace digital technologies, and a shift change to work differently has been forced upon all areas of the health service this year.

  • Guest blog: David Hotchin
    11 December 2020

    This week we have a guest blog that was submitted to us by David Hotchin, written by a retired friend....obviously, he's used a little poetic licence.

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

  • Virtual Consultations– the patient perspective
    2 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article.

  • Virtual Consultations– the patient perspective
    1 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article - Virtual Consultations– the patient perspective.

  • Celebrating innovation in eye research
    24 September 2020

    This week Julian Jackson from VisionBridge has shared a report on eye research.

  • Link of the week: Comprehensive Spending Review and Covid-19
    24 September 2020

    This week we are sharing a blog that outlines the funding pressures and uncertainties faced by the health and care system

  • Risk stratifying elective care patients
    10 September 2020

    This blog has been shared by MBI healthcare technologies. As services are starting to treat routine patients those on waiting lists are making enquiries as to where they are on the list, and if they are still on the list.

  • Link of the week
    4 September 2020

    This week the link we would like to share are reflections from physiotherapy students on placement at Alzheimer Scotland https://letstalkaboutdementia.wordpress.com/

  • Link of the week
    28 August 2020

    This week we would like to share a blog published on the Mind website about being a BAME health worker in the pandemic.

 
 
Thursday, 3 December 2020

What now for commissioning?

By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

NHS policies since 2014 have increasingly been provider orientated leaving commissioners in at the least, a state of flux. Commissioners in general have had little impact on primary care largely as contracts for the independent contractors are negotiated nationally, but local opportunities have arisen in the past. During the NHS Reforms of 1991 many commissioners supported the development of practice based budgets; Personal Medical Services (PMS) a national policy introduced in 2004 and updated 2015, initially offered an opportunity to locally rectify or at least ameliorate the historic lower funding of GP practices serving social deprived populations. In the Primary Care Home programme commissioners who supported the programme demonstrated their most significant support to primary care.

Maybe the clue could be in the name, not buying quantity and forcing quality but commissioning high value care for patients with value defined as the health outcomes achieved for money spent. Commissioning should entail enabling providers who possess almost exclusively the clinical knowledge, to set their own quality and performance indicators against which they will hold them to account. It would be naïve to think all providers will without hesitation set high and stretching indicators, in which case commissioners will need to rigorously apply the available local and national quality indicators implemented piecemeal around the country. Enabling and then holding to account is paramount and patient involvement and feedback mandatory.

What of the commissioning of primary care? General medical practice and PCNs are provider organisations which by dint of their population responsibilities can undertake some of the current roles of commissioners and ideally beyond. To go beyond healthcare and to be ‘of the people’ all NHS providers must be working to embrace population health. Hospitals argue, wrongly, that they have little impact on some of the broader healthcare determinants, such as obesity, exercise or smoking, and that it is somebody else’s job. It is certainly a challenge, but hospital clinicians are highly influential, especially from a patient perspective. . Arguably the main failure of NHS commissioning in its present mode of working is its inability to improve the value of hospital services and ensure whole healthcare system working.

Partnerships between commissioners and all providers can manifestly optimise where and by whom care is delivered and where achieved, the new way of working embedded and spread. Uncommon practice in the NHS where piecemeal is often the order of the day, but hopefully much more achievable with the development of larger and more strategic commissioners. All providers should take a population responsibility and a growing number are. What an opportunity for providers and commissioners working in an openly accountable partnership. Structure and formal working being insufficient in itself to elicit change, a leadership imperative is the identifying and sustaining of allies and alliances from all parts of the health and care system of those who wish to work in new ways.

NHS Policy is promulgating organisations to work in systems thereby adding value to their solo working. There is a novel challenge for commissioners as the NHS comes to terms with a policy shift from its classic nationalisation and hospital centric past. Not only how can PCNs be commissioned but how to commission for the individual patient who currently has little influence and choice? Complex issues can only optimally be addressed locally. For the individual patient the NHS has much to learn from local government that focuses much more on the individual citizen.

As ever adaptive leadership. PCNs must be regarded as a network of organisations and people that must be maintained and nurtured to guarantee localness. At the other end of the size scale multi providers and commissioners to work cohesively together in partnership to serve their larger community. As the concept of a complex adaptive systems is fully grasped a new governance is essential, a collaborative governance underpinned by relationship governance. Not the compliance based top down traditional NHS governance, but one defining relationships, behaviours and responsibilities. The principles and behaviours that underpin any successful alliance, such as ‘no disputes’ [which is not to say, no disagreement]; a ‘best for citizens’ rule; the need to work in good faith and the critical importance of trust; and the necessity for transparency and for any alliance to be transparent to its population. Contracts are necessary but should underpin relationships, not define them.