“Clinical Commissioners Present and Future - how can the private sector best support their aims?”

1. “Clinical Commissioners Present and Future - how can the private sector best support their aims?” CAPITA Conference Church House Conference Centre Tuesday 10th June 2014 Dr Michael Dixon Chair NHS Alliance President NHS Clinical Commissioners

3. The vision • The delivery • The obstacles • Current policy • The future

4. The Vision Commissioning that is:- • Locally sensitive • With a primary care focus • Moving services from hospital to primary care • Improving personal and local health • Based on outcomes

5. The Delivery • 211 authorised CCGs (only 3 with directions) and most within budget • Clinically led • Many examples of innovation – “taking the lead” • With a representative organisation “NHS Clinical Commissioners”

6. The Obstacles • CCGs joined a party that had started without them • NHSE/CCG not yet seen as equal partnership – e.g. arbitration process • Payment by Results (National Tariff) can favour provider • Commissioning poorly integrated between specialist/hospital and primary care – e.g. cancer • CCGs becoming “financial risk sink” – e.g. specialist care/primary care/continuing care

7. The Obstacles (Contd…) • Variable support (CSUs) • Competition law, Section 75, 25% of CCGs putting out tenders only because they think they have to • Are frontline clinicians, especially GPs, on board? • Lack of headroom and resource in general practice and primary care – diminishing share of NHS budget

8. Gearing of investment across the system Public Health Social Care GDP

11. Current Developments • CCGs as co-commissioners of primary care (and ?specialist care) • Better Care Fund • Improving primary care – care and continuity for the frail elderly • Integrated care

12. Integrated Care • General practice at scale – Federations/Social Enterprise/Companies • Hospitals joining forces with primary care • Alliance contracts (e.g. Leicestershire) • Accountable Care Organisations

13. The Future Political • Will CCGs remain at the centre of commissioning? • GPs – Independent contractors/salaried. Increased investment in general practice • Specialists – contracts where? • Re-disorganisation?

14. The Future NHS England • How will the Stevens era differ from the Nicholson era? • Will NHSE be able to stem the tide of local change initiated by CCGs and local offices working closer together. • What will be the role of NHSE when CCGs are commissioning primary, secondary and specialist services?

15. The Future Commissioning/Contracting • Payment by Results becomes recommended retail price • Focus will move to improving current contracts • Tendering, when current contractor is not delivering – tendering for outcomes and integrated care – e.g. lead provider and alliance contracts • Transparent accounts/profit caps • Any qualified provider – with managed demand

16. The Future Changes in Provision • Integration • Improved and extended local care and access for the frail elderly and those with long term disease • Better primary care access to diagnostics • De-medicalising health and care – self-care, improved personal health, empowering health creating communities (e.g. social prescription) • Role of primary care and Local Authorities as main catalysts of local health

18. What can the private sector offer? • Business acumen and financial knowledge • Experience in cost efficiency • Knowledge around commissioning/contracting/bidding • Understanding of markets and consumer needs

19. How should private sector interact with the NHS? • Support • Complement • Compete

20. Getting Started • Understanding that commissioners and providers want “more for less” and will listen to anyone that helps them to achieve this • Preliminary diagnostic/makeover followed by an offering • Providing choice of a small selection of well proven/trod options/packages

21. Possible Areas of Involvement for Industry • Anything that reduces hospital bed days • Anything that reduces costs or improves cost efficiency • Improved diagnostics in the community • Support for self-care and improving individual and community health. • Initiatives that support improved relationship between commissioners and public and GP practices • Helping with QoF and other “must dos”

22. How should industry engage with the new commissioners? • Understand and identify with their aims and perspectives • Any offers need to explicitly meet the commissioner’s needs • Transparency is essential • Risk sharing, where cost efficiency is not guaranteed • Innovation is the name of the game • Recognise the dual role of clinicians as commissioners and providers

23. Commissioning • Commissioning support where required • Helping with infrastructure/management/supplies • Helping commissioners with service specification and putting out tenders - e.g. for integrated services • Helping to reconstruct in specific disease areas – e.g. mental health, dermatology and musculoskeletal services • Helping CCGs to fully involve member GP practices • Creating a method and “norm” for commissioning for outcomes and “closer commissioning”

24. Provision • Providing the services that others are not offering or not offering adequately – e.g. prison services/homeless services/services for the frail elderly (where the GP practices are not stepping up to the mark) • Supporting GP practices to work “at scale” in Federations/companies/social enterprise units • Providing headroom/leadership/time/experience and resources for GPs to do so “without tears” • Being a member/convener/lead provider of an “alliance style” contract

25. Provision (Cont/d…) • Enabling hospitals to develop primary care services as an integrated package • Creating an Accountable Care Organisation (including Community Hospitals and all primary care services) • Providing support functions for provider organisations (e.g. bulk purchasing for GP Federations) • Putting in bids as any qualified provider

26. “There will be no return to the old centralised command and control systems of the 1970’s” “Successful local arrangements will be built upon, not discarded. The approach will be bottom up and developmental”. “Each group will be required to be representative of all the GP practices within the group”.

27. “There will be no return to the old centralised command and control systems of the 1970’s” “Successful local arrangements will be built upon, not discarded. The approach will be bottom up and developmental”. “Each group will be required to be representative of all the GP practices within the group”. The New NHS: Modern and Dependable - 2000