1 / 24

The Commissioning Cycle

The Commissioning Cycle. The Commissioning Cycle. The steps: Needs assessment Service provision review Priorities Quality outcomes Design services / pathways Providers/suppliers Demand management Clinical decision making Manage performance and outcomes. Underpinned by:

lynda
Download Presentation

The Commissioning Cycle

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Commissioning Cycle

  2. The Commissioning Cycle The steps: • Needs assessment • Service provision review • Priorities • Quality outcomes • Design services / pathways • Providers/suppliers • Demand management • Clinical decision making • Manage performance and outcomes Underpinned by: • Primary care involvement • Public and Patient engagement • Evidence based practice

  3. Assessing Needs Data Manage Quality & Performance Assessing Needs Prevalence Review Service Provision Clinical Commissioning Clinical Decision Making Morbidity & mortality Risk factors & lifestyle Service access Decide on Priorities Manage Demand Capabilities Segment & trend analysis Specify Quality Outcomes ‘Market’ Intelligence Contract providers Design Services & Pathways Tools Data collection & reporting

  4. What is needs assessment?Needs assessment identifies and strives to eliminate overuse, misuse and underuse of healthcare resources • A variety of comprehensive evidence sources can be used that include, but are not limited to the following: • Local knowledge of clinicians, health care providers, commissioners • Local Authorities • Practice based commissioning data • Prescribing data • Prevalence and incidence data • Community health profiles • Housing data • Inpatient and outpatient data • Lifestyle data • Educational attainment data • Deprivation indices • Views of patients/service users • Census and other demographic data • Referral data • Joint Strategic needs Assessments (JSNAs) are local assessments of current and future health and social care needs that could be met by the local authority, CCGs, or the NHS CB • JSNAs and the Joint Health and Wellbeing Strategy is produced by health and wellbeing boards to set priorities for future action.

  5. Review Service Provision Data Manage Quality & Performance Assessing Needs Current performance Review Service Provision Clinical Commissioning Clinical Decision Making Knowledge National indicators Clinical outcome measures Decide on Priorities Existing evidence base Manage Demand Capabilities Specify Quality Outcomes Best practice definition Contract providers Cost effectiveness analysis Design Services & Pathways Tools Benchmarking tools

  6. Review current service provision • Service reviews are undertaken to demonstrate a thorough understanding of current services provided in relation to the identified health needs. In essence, it is to ensure that services commissioned for the population are effective and of high quality. • Key tasks to be considered as part of a service review include:- • Understanding the operational delivery, workforce issues and clinical factors for the service • Developing knowledge of clinical effectiveness and evidence base • Benchmarking service against national or other indicators to access efficiency • Reviewing applicable performance indicators or monitoring clinical outcomes • Reviewing user experience and satisfaction with the service • Establish best practice clinical/public health guidelines for the service 

  7. Decide on Priorities Data Manage Quality & Performance Assessing Needs Patient feedback Review Service Provision Clinical Commissioning Clinical Decision Making Knowledge Patient population analysis Systematic reviews Decide on Priorities Manage Demand Health economic analysis Capabilities Specify Quality Outcomes Contract providers Evidence synthesis Design Services & Pathways Benefits case development Patient communications

  8. Decide and agree Priorities • PCTs need to ensure that both national and local priorities are considered for inclusion in its Strategic Commissioning Plan and Annual Operating Plan, and that appropriate and sufficient stakeholder engagement (local clinicians, GPs, patients, public) is included in the decision making process. • Priorities are generated from insights from:- • Public & patient engagement • Joint Strategic Needs Assessment  • Clinical Evidence • Programme budgeting or equivalent. • Defined criteria for evaluation and prioritising investment and disinvestment should be developed including:- • Quality • Local Needs • Impact on health outcome gains and inequalities • NICE guidance/guidelines • Costs and Productivity

  9. Specify Quality Outcomes Data Manage Quality & Performance Assessing Needs Current Achievement Review Service Provision Clinical Commissioning Clinical Decision Making Knowledge Benefits case Existing outcome measures Decide on Priorities Manage Demand National quality indicators Capabilities Specify Quality Outcomes Contract providers Outcome measure design Design Services & Pathways Audit design

  10. Specify and agree quality outcomes • CCGs must align their strategic plan and priorities with the key quality outcomes which they intend to deliver for their population. • Outcomes that are chosen will need to be underpinned by quantifiable data, in order to provide a basis against which they can be monitored. • Increasingly, national indicators which quantify health and patient reported outcomes are being used by PCTs to measure quality improvement. • Further information on key quality outcomes agreed for NHS Milton Keynes are outlined in the Strategic Commissioning Plan  & Annual Operating Plan . For a full list of national indicators which the PCT is measured against see NHS Milton Keynes Care Quality Commission’s Annual Health Check. • The CCG should also take account of the NHS, Adult Social Care and Public Health Outcomes Frameworks, the Commissioning Outcomes Framework and outcome strategies

  11. Design Service & Pathway Knowledge Manage Quality & Performance Assessing Needs Existing pathways Review Service Provision Clinical Commissioning Clinical Decision Making Evidence synthesis Evidence summaries for single interventions HTAs Decide on Priorities Manage Demand Capabilities Pathway adaptation Specify Quality Outcomes Contract providers Pathway development Design Services & Pathways Guideline enablement

  12. Design services and pathwaysThis element of the commissioning cycle is all about PCTs being able to identify improvement opportunities, based on national/international best practice, which ensure that services across settings are coordinate and integrated. 1. Prioritise – rationale for the work, based around strategic priorities2. Start Up – preparing for the review, establishing project team3. Review – conducting the review, including gap analysis and needs assessment4. Redesign & Option Appraisal – identifying the optimal model of care, testing of options and option appraisal5. Provider Development – assessing the market, shaping supply & contract issues6. Business Case – establish value for money & effectiveness of the proposed new service/pathway.7. Vision – recommend and promote the ethos of new service, gain stakeholder support. 8. Specification – develop service or pathway specification, including quality outcomes desired, for the proposed change9. Approval – gain organisational approval and financial resources for progressing the new service/pathway.10.Procurement – agree process by which new service/pathway will be contracted for.11. Implement – develop a plan for implementing the new service/pathway and delivering the change12. Monitoring & Review – monitor progress in achieving the required outcomes and service specification compliance.

  13. Contract with Providers Data Manage Quality & Performance Assessing Needs KPIs, Outcomes Review Service Provision Clinical Commissioning Clinical Decision Making Knowledge National and local contracts Decide on Priorities Tools Manage Demand Quality Standards Specify Quality Outcomes CQUINs, PROMS Contract providers Capabilities Design Services & Pathways Contract management Negotiation skills

  14. Contract with Providers / Supply • The contracting process ensures that formal agreements with all providers (acute, primary, community, mental health, voluntary sector) are in place, and that these contracts clearly set out what is expected from both the commissioning and the provider. • Within these contracts, PCTs can • Specify quality requirements or outcomes (e.g. CQUIN, PROMs) • Incentivise the development of new service models or patient pathways • Ensure quality of care for service users • Ensure value for money

  15. Manage Demand Data Manage Quality & Performance Assessing Needs Existing service usage Review Service Provision Clinical Commissioning Variation between providers Clinical Decision Making Prescribing data Knowledge Decide on Priorities Evidence base for reducing LOS, complications and cost Manage Demand Referral best practice Specify Quality Outcomes Tools Contract providers Design Services & Pathways Risk assessment tools Order sets / care bundles Educational resources

  16. Manage demand and ensure appropriate access to care • CCGs will need to have in place a range of responsive providers that they can commission healthcare services from. • However, they also need to be able to understand and predict current and future demands on those services to ensure that they can accurately predict required future capacity for the population needs identified. • Employing their knowledge of future priorities, needs and community aspirations – CCGs can use their role as leader of the local NHS to influence improvement, choice and service design in ways that can best meet future demands.

  17. Clinical Decision Making Manage Quality & Performance Knowledge Assessing Needs Best practice guidance Review Service Provision Clinical Commissioning Clinical Decision Making Guidelines Pathways Tools Decide on Priorities Manage Demand Referential decision support Order sets / care bundles Specify Quality Outcomes Contract providers Clinical prompts Design Services & Pathways Integrated decision support ‘Just in time’ learning

  18. Clinical decision making • The CCG must build a strong framework of clinical involvement in its decision making to ensure that it can:- • Develop a greater range of more integrated services in community settings • Secure great investment for upstream or preventative interventions that keep people healthy for longer, prevent ill health and reduce inequalities • Drive continuous quality improvement and innovation across the whole system.

  19. Quality & Performance Data Manage Quality & Performance Assessing Needs Real time performance Review Service Provision Clinical Commissioning Clinical Decision Making Variation between providers Knowledge Performance analysis Decide on Priorities Manage Demand Best practice guidance Tools Specify Quality Outcomes Decision support tools Contract providers Design Services & Pathways Learning needs assessment Performance linked educational resources

  20. Manage quality, performance & outcome • In order to assess whether their strategic goals are being achieved, CCGs need to manage quality and performance of commissioned healthcare effectively. • This will involve monitoring and managing the performance of providers against their contracts, including specific quality indicators or key performance indicators. • Good data and information sharing systems, plus constructive performance discussions are crucial to this element:- • Ensuring monthly, quarterly or annual performance reviews are in place as appropriate • Clarity as to what checking/ verification is to be done, by whom and how frequently • Agreement on what Indicators /KPIs are to be measured, by whom and how frequently. • How are the results to be communicated and to whom • Who is responsible for following up concerns and in what forums.

  21. NHS Milton Keynes CCG Management FrameworkInternal decision making structure Clinical Programmes & Projects Network of member practices NHS MK CCG Senior Management Team NHS MK CCG Board advisory reports to Stakeholders Service providers Health and Wellbeing Board Clinical Networks Clinical Senate Acute Service Review Partner Organisations Patient Congress Practice Participation Groups LINk:MK Co-operation & Competition Panel NHS MK CCG Delivery Group External resources Commissioning Support Hub Joint Commissioning Team Neighbourhood Quality & Performance Groups (4) Children & Maternity Programme Urgent Care Programme Planned Care Programme Mental Health Programme Long Term Conditions http://www.miltonkeynesccg.nhs.uk/governance_structure/

  22. Commissioning in Milton Keynes • Read about commissioning in Milton Keynes http://www.miltonkeynesccg.nhs.uk/commissioning-in-mk/ • Read about the work of the Milton Keynes CCG Programme Boards: http://www.miltonkeynesccg.nhs.uk/commissioning_programmes/ • See the Commissioning Toolkit of resources to support the work of commissioners: http://www.miltonkeynesccg.nhs.uk/commissioning_toolkit/ • Sign up for alerts to keep you abreast of the latest commissioning resources – Anne Gray - Commissioning.librarian@miltonkeynes.nhs.uk

  23. Compiled by Anne Gray, Knowledge Officer NHS Milton Keynes CCG September 2012 With acknowledgement to Dr Andrew Jones, Clinical Specialist and Lead for Commissioning, BMJ

More Related