MPs told to ‘free’ PCTs of acute commissioning

Posted on January 21, 2010. Filed under: News stories | Tags: |

Health Service Journal | 21 JANUARY 2010 | BY NICK GOLDING

Primary care trusts should be “released” from commissioning acute care and left to concentrate on improving primary and community services, MPs have been told.

York University professor of health economics Andrew Street suggested that the Department of Health should fund hospitals directly, as part of his evidence to the Commons health select committee inquiry into commissioning last Thursday.

He said it was “difficult” for PCTs to control costs, a task made harder since the introduction of the payment by results tariff system.

Professor Street warned: “They are at financial risk.”

In his written evidence he said: “Either PCTs should be given the means to negotiate on an equal basis with hospitals or – more radically – they should be released from having to deal with hospitals altogether.”

He told the MPs: “This role could be undertaken centrally and PCTs would focus on the more neglected areas of primary and community care where there’s a considerable need for action.”

His written evidence added: “The transfer of responsibility would allow the DH to sharpen the incentives of payment by results, using the tariff more effectively to control volume, and it would better facilitate free patient choice of hospital.

PCTs that successfully kept patients out of hospital would receive a proportionately larger budget from primary and community care, he suggested, with the proportion increasing over time if strategies to reduce referrals proved successful.

But NHS North Yorkshire and York director of public health Peter Brambleby told the committee that he disagreed with the proposal.

“It’s important that someone is tasked with ensuring that the deployment of resources for that community genuinely reflects its needs,” Dr Brambleby said.

PCT Network director David Stout told HSJ commissioning was about improving patient pathways, not simply about payments between different organisations.

He said there were numerous attempts to invest in community based services, including community matrons and telemedicine to reduce the length of hospital stays or avoid unnecessary admissions.

However, he admitted PCTs had struggled to reduce acute activity and would need to do so in order to invest in community based services in the leaner years of public spending to come.

“The DH would have less means of influencing acute demand than PCTs,” he said.

Westminster PCT chief executive Michael Scott also disagreed with Professor Street’s proposal. “Controlling acute activity is undoubtedly challenging. But this isn’t the answer.

“The answer is to aggregate the scale to get the leverage you need.”

Mr Scott heads the North West London commissioning partnership, which aggregates commissioning across eight PCTs, with an acute commissioning budget of £1.4bn.

He said Professor Street was proposing the “ultimate aggregation” by centralising all of acute commissioning, but that took aggregation too far.

“You would lose local control and flavour and you wouldn’t be able to incentivise shifting care from the acute to community sector,” he said.

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BMA rejects Tory ‘GP-led rationing’

Posted on December 10, 2009. Filed under: News stories | Tags: , |

Healthcare Republic | GP newspaper | By Richard Staines | 10 December 2009

As the BMA launches its general election manifesto, Richard Staines looks at the political battle lines being drawn.

Dr Meldrum: 'Patients must be involved in discussions about how to deliver care, rather then rationing through a sort if fundholding'

The BMA is on a collision course with the Conservatives over plans to hand GPs control of NHS commissioning.

The Conservatives, favourites to win the next general election, want to hand GPs real budgets and responsibility for all NHS commissioning.

But at last week’s launch of the BMA’s general election manifesto, doctors’ leaders opposed the Tory policy, saying it would place GPs at the centre of an NHS rationing system.

Commissioning debate
The BMA is calling on all political parties to adopt its manifesto ahead of the general election, which must take place by 3 June 2010.

According to the Conservatives’ NHS Improvement Plan, budget holding is a ‘natural guarantee of efficiency, ensuring money follows the patient and it is spent on front-line care rather than on managers’.

‘GPs – rather than remote managers – should be responsible for reconciling the available resources with clinical priorities and patient choice,’ it says.

But launching the BMA manifesto, BMA chairman Dr Hamish Meldrum said: ‘I am not convinced this is going to be appropriate for GPs. We would like a much more co-operative system. Patients must be involved in discussions about how to deliver care, rather than rationing through a sort of fundholding.

‘We would want to see co-operative community primary care leadership involving patients, involving GPs, to build effective healthcare services.

‘I am not sure GPs would want to take responsibility for rationing services.’

Other NHS organisations agree. The NHS Alliance opposes fundholding and argues for local commissioning councils governing populations of around 100,000 people.

Dr David Jenner, GMS lead at the NHS Alliance, says: ‘The responsibility for commissioning should be outside the GP provider contract. But we do believe the GP provider contract should put more emphasis on demonstrating effective resource management.

‘Each practice should demonstrate that it is reviewing everything from prescribing to referrals to ensure the best use of resources.’

Despite the opposition, the Conservatives say they will argue their case. A spokesman said: ‘A lot of family doctors think that having more responsibility for their patients is a good thing. We are going to work with GPs to push this through.’

One set of GPs more likely to back the Tory stance is the National Association of Primary Care, whose own manifesto launched last month backed GP budget-holding and won support from the Conservatives.

Calls to action
The DoH says it remains committed to ‘revitalising’ its current policy of practice-based commissioning (PBC), with PCTs retaining control of budgets.

PBC was described in October as a ‘corpse’ by the government’s national clinical director for primary care, Dr David Colin-Thome, although he later backtracked on the remarks.

But a study by the King’s Fund in July showed 52 per cent of primary care professionals were not engaged in PBC by their PCTs and almost a third (29 per cent) of respondents reported delays of more than 25 weeks getting PBC business plans approved.

The BMA manifesto also reiterates calls for changes to the GMS contract to boost partnerships. ‘Changes could make it more attractive to take on additional partners, particularly in areas of greater need,’ says Dr Meldrum.

In addition, the manifesto warns against a ‘slash-and-burn’ approach to tackling the financial crisis. ‘It would be disastrous to resort to measures such as cutting front-line services and clinical staff at a time when demand for healthcare will be increasing,’ says Dr Meldrum.

The BMA also reiterates its call for action to combat alcohol-related harm, tobacco use and obesity.

Measures proposed include above-inflation tax rises on alcohol, minimum pricing, an end to ‘happy hours’ and a total ban on alcohol advertising.

The association wants to see a tobacco-free society by 2035, and the manifesto urges the DoH to tackle obesity by introducing consistent traffic-light food information systems and banning on junk food advertising.

Action must be taken to cut climate change and its effects on health, the document adds.

It also reignites the debate on organ donation, backing the ‘presumed consent’ model the DoH has rejected.

BMA MANIFESTO AT A GLANCE

  • Increased alcohol duty and a ban on alcohol advertising.
  • Increased tax on tobacco and censorship of films glamourising smoking.
  • National traffic-light food information to cut obesity and ban on advertising for unhealthy foods.
  • A public debate on an opt-out system for organ donation.
  • Political parties should combat climate change and its negative health effects.
  • GPs should be engaged with practice-based commissioning, but not fundholding.
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New procurement rules ‘may increase private provision in NHS’, says DH

Posted on November 24, 2009. Filed under: News stories | Tags: , |

Pulse | By Nigel Praities | 24 November 2009

Switching to the NHS being the ‘preferred provider’ may increase private provision in the health service rather than reduce it, says a DH spokesperson.

The claims come after newspaper reports of a backlash from business leaders and politicians against the Government’s decision to issue strict new guidelines to PCTs about the use of private providers.

Health secretary Andy Burnham first revealed in September that under-performing NHS providers would be given ‘at least two chances’ to improve before turning to alternative providers.

Ministers have denied this is a U-turn in policy, but the change has prompted criticism from former minister Alan Milburn and the CBI, according to The Times newspaper today.

A Department of Health spokesperson would not comment on the existence of new guidelines for PCTs, but said where existing NHS services are delivering a good standard of care for patients there was ‘no need to look to the market.‘

‘Where Primary Care Trusts are commissioning new services, then we expect them to engage with a range of potential providers before deciding whether to issue an open tender.

‘These decisions will be made locally and we will not choose to exclude either NHS or private providers on grounds of ideology – quality and what is best for patients must always come first. This could well mean more private provision, not less,’ he added.

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PBC innovation through creating a new company

Posted on November 17, 2009. Filed under: Commissioner, News stories | Tags: , , , , |

Pulse | Focus on…..Social Enterprise | 17 November 2009

Dr David Morris and Dee Kyne explain how they remortgaged their practice to kick-start the process of PBC innovation in their area

When I came into general practice in 2000, I found it immensely frustrating that patients would come back time and time again with the same problems. Faced with a 20-month wait before they can do anything for them, their GP can feel powerless. And so we began to look for a way to have more control and to find a better, more efficient and more rewarding way of working.

Accessing the right person in the health service is difficult at the moment and often requires several steps. We wanted to create a service that would ensure efficient and streamlined access to the right person at the right time in the right place, and would take the surgery to the patients – rather than the patient having to come to us.

All change needs a driving force and models of successful innovation, but few are willing to take the necessary risks. PCTs tend to be risk averse as their priority is to make the finances balance. GPs often feel they should be insulated from risk and PBC clusters are often defined by geography rather than attitude to risk and willingness to innovate. The other 22 practices in our PBC cluster weren’t ready to take the next step. So we took it alone.

Setting up the social enterprise

We decided the best model to adopt would be a social enterprise so we could take the risks necessary for successful innovation, which others could then follow.

In 2006 we decided to establish a community interest company, which we called Pathfinder Healthcare Developments (PHD). We decided on this approach so that we could access funds and prove we had a strong governance framework. We reinvest our profits and assets for the public good. The idea was initiated by Dr Niti Pall, a partner in our practice and PEC chair at the time, and took about a year to develop. The company started in 2007, then took around nine months to really take off. The company is now owned by the practice along with business development director Dee Kyne, who was brought in to set up the social enterprise. The company was initially run separately from the practice. It now covers three practices.

The 11 partners invested £34,000 of their own money (about £3,000 each) to start the company and support initial staff salaries. As the company has grown, it has been able to pay the current 12 staff salaries out of its turnover.

A further investment to fund redesign of our primary care services came in a £200,000 loan from the Big Issue Invest – a fund that invests in groundbreaking social enterprise. We were its first health investment. The partners took the risk of underwriting the loan by remortgaging the practice premises.

PCT involvement

At this stage, our PCT, Sandwell, had not invested in the company. We started on a programme of redesigning our services using the £200,000, focusing on preventive care and early intervention, which is where we will eventually make the most significant savings.

Once the PCT could see what we were doing, it came on board and in various ways has invested around £400,000 of its own money. It has paid for us to run the community aspect of its CVD programme and contributed to the risk stratification analysis (see right) and workforce development for both clinical and non-clinical health professionals across the cluster. (We had already funded this with some £25,000.) The PCT invested a further £35,000 to develop a supervision and medical mentoring programme for the cluster.

Some of the money has also come from the PCT’s innovation fund. It is very supportive of what we are doing and has given us almost total freedom. The social enterprise has put us in a strong position to bid for contracts such as PMS Plus, APMS, LESs and DESs.

We work with the PCT collaboratively – we don’t have to ask for permission. It’s a healthy relationship – the innovators push the agenda and hold the power because we are the providers and we are very close to the patients. A PCT is more restricted in this area because it is trying to be a good banker.

PBC involvement

Although PHD has no immediate direct link with PBC, we’re using the practice development as a pathfinder-incubator company for areas in PBC. What we’re trying to do is linked very clearly with the set aims of PBC: improving primary care access, moving more services to primary care and minimising unnecessary use of secondary care.

Having an incubator company in the cluster enables us to test innovation. We have taken huge gambles to see if we can restructure the way we offer primary care services. That then becomes available to the PBC cluster and sets the tone for what may be achieved as a collective. Others in the cluster have access to everything we’re achieving, such as IT innovation and risk stratification of the managed population.

Data

We have worked with Aetna, which is one of the Government’s Framework for External Support for Commissioners (FESC), to develop a robust risk stratification tool.

This uses primary and secondary care data to establish how our patient population is at relative risk of becoming unwell and allows us to become a very effective health population manager. This is being used though the cluster and is supported by the NHS Evidence Centre.

The data has dispelled some myths about how our patients access healthcare and has shown us the areas we need to change.

For example, when we started out we believed diabetes and mental health were our ‘low-hanging fruit’. But when we risk-stratified the population, the high spenders turned out to be asthma in young people and people who had two or more long-term conditions. Interestingly, the latter group was any combination of any two conditions. So we realised that no single condition drives urgent admissions and therefore that care management that focused on specific disease areas would not meet patients’ needs.

This information showed us the way forward and led to the development of a model of work that will ultimately reshape services to the benefit of everyone.

Our aims became:

• to redesign services to improve access in primary care

• to keep people well who are currently well and reach out to those we don’t normally see

• to maximise the health of those who do have illness in a targeted way, focussing on those with more than one illness through a care management programme

• to develop staff and personnel in a very positive way

• to provide value for money – not just providing cheaper services but making sure costs aren’t multiplied by ensuring patients are seen by the right person at the right time.

The service redesign model

The service redesign model we have developed comprises various elements, as follows.

Self-care

We are developing personal care packages, working with people in their homes and looking at how technology can help them.

This service promotes confidence in self-management and provides an opportunity for community members to develop skills that improve the health of others in the community. We are also exploring using telemedicine.

Outreach/inreach

Working within communities that have not until now been contacted proactively, for example church communities, Gurdwaras, mosques, pubs and shopping centres.

We have carried out mid-life health check sessions in supermarkets, connecting with more than 500 people. By actively looking for patients at risk of ill-health this service will reduce inequalities in health.

On behalf of the PCT we carried out the community aspect for the CVD programme. We were so successful in engaging members of the community that we now have a 45-strong volunteer force who have become health champions. This has rolled out into the cluster and is now operating across the whole of Sandwell.

This group now forms the bones of a patient reference group, which will be an important part of everything we do in the future.

Fast-track referral and treatment

We have triage and clinical assessment teams working closely together to ensure people are no longer slowed down by the system. Clinicians and support staff are streamlined into effective multidisciplinary teams.

Signposting

This aims to identify all the resources locally that can help to improve people’s health – whether this is simply identifying a local ramblers’ club, or putting someone in touch with the Citizens’ Advice Bureau to discuss housing needs.

We set out to bring together the information on a single website to make it as up to date and easily accessible as possible. We anticipate it will go live at the beginning of 2010.

Group consultations

This is a new style of consultation, for practice staff and patients with long-term conditions or recurrent acute conditions, delivered at the practice. It means a reduction in the use of primary care resources as well as better use of the most appropriate clinical expertise.

Diabetes and asthma group consultations are now a part of daily life at the practice. We will be launching other groups shortly, including back pain and hypertension.

Outcomes

Our model uses primary care as an agent of regeneration and raises expectations in a community that traditionally has low aspirations.

At this stage we are creating our own freed-up resources through redesigning primary care so we can then focus on innovation in secondary care redesign with our secondary care colleagues.

We have seen a slight reduction in non-elective procedures but can’t at this stage say it’s because of what we’re doing. We are now 13 months into our new way of working and all the financial modelling we have done suggests that by year five we will have made a saving of £40 a patient – £400,000 for a population of 10,000 through keeping them out of secondary care. The big win is that this money will be reinvested into NHS services.

We have taken this risk to get us where we need to be for contract reviews. We now have the power to negotiate and develop services. If we’d taken no risk we wouldn’t be in that position.

What we get from this is autonomy – developing the level of services we believe we should be developing.

The future

We talk in terms of becoming a health management organisation that would manage the whole of the patient’s capitated budget – the natural evolution for PBC.

We would like to call ourselves a social

HMO and bring together a lot of the social public health services that impact on our patients’ lives.

We are working towards holding our own budgets to provide outstanding excellence in primary care, with full control over the health economy spend of the patients we have responsibility for and delivering that as effectively and efficiently as possibly. We will take on the real budget risk with the PCT.

Once we move into a more sophisticated system of earned autonomy we intend to set up an effective discharge-planning programme and support service.

Dr David Morris is a GP partner at Smethwick medical centre, West Midlands, and partner in Pathfinder Healthcare Developments

Dee Kyne is business development director of Pathfinder Healthcare Developments

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How our social enterprise model moved PBC up a gear

Posted on November 17, 2009. Filed under: Commissioner, News stories, Social enterprise | Tags: , |

Pulse | Focus on…..Social Enterprise | 17 November 2009

Dr Bill Tamkin explains how becoming a social enterprise helped his PBC cluster get ahead in the game

Turning our PBC group into a social enterprise company has given us more clout with providers and the PCT. Manchester Practice-Based Commissioning (South) Ltd grew out of our consortium of 26 practices known as the South Manchester PBC Hub, which was launched four-and-a-half years ago.

There was a long history of like minded working between practices. When PBC came in, the PCT encouraged us to start working as a consortium but reorganisation in 2004/5 meant a dramatic slowdown.

Most of the people we knew in the trust disappeared and we were left in limbo as the three trusts merged into one – NHS Manchester. There was a lot of frustration from GPs and we felt we would be more effective if we had a formal set-up.

The decision to opt for a social enterprise format was both practical and philosophical. We had seen it working in Stockport and we wanted charitable status – to be a company for the community rather than being about profit for shareholders.

Having now created the social enterprise, we have the potential to hold a real budget for our 160,000 patients and an agreement to provide commissioning support to the PCT with a devolved budget of £1m.

Relationships

We wanted to focus on three key relationships:

• with the PCT

• between our practices

• with the main providers.

Members felt we needed some clarity about what the new PCT expected from us and what our role was.

There was also a need to firm up relationships between practices. We are all independent and most of the time work in isolation – a more formal relationship where we all agreed to move in the same direction would be very powerful in terms of improving the quality of primary care as well as helping us negotiate with the acute sector and the PCT.

GPs had very little ability to negotiate with providers on behalf of patients. There were daily frustrations about the struggle to get good care. Tales of inefficiency, long waits, duplication of tests and futile outpatient appointments spurred us on.

Sometimes trusts would refuse to see patients because they were in the wrong patch – Manchester is one of the largest metropolitan areas in the UK with a population of more than 2.5 million and there are a number of large, powerful providers, from the University Hospital South Manchester to the Manchester Royal Infirmary, Pennine Acute, Central Manchester and others. We had no influence over these trusts as individual GPs but as a corporate entity we would be able to negotiate on behalf of 160,000 patients.

There was also a need to make sure the new organisation had longevity rather than simply relying on a few enthusiasts. We wanted to set up something that would be sustainable in its goal of improving the health of the population we care for.

And we wanted to look to the future – whichever political party comes into power, it’s clear healthcare spending can’t keep going up and up. PBC is currently the only game in town to tackle this. And as a legal entity we have the potential to hold a real budget for our 160,000 patients.

What kind of model?

We looked at various structures and took advice from people who had been there and done that, such as our neighbours in Stockport PBC who had set up a social enterprise – a business or service with social objectives where surpluses are reinvested, rather than being driven by the need to maximise profit for shareholders.

We wanted commissioning to be credible with our patients and the PCT. The idea of joint ownership, all being in this together, seemed to fit our approach.

But setting up the organisation was a cumbersome process. From the initial idea four years ago, it has only been in the past 18 months that things have started to happen.

We took the idea to one of the PBC group’s quarterly meetings where all the 26 practices came together and supported the plan. But it took a year to win hearts and minds at the PCT, which was frustrating.

We had to keep plugging away, building relationships and showing we had a robust vision. It was about understanding the issues and the pressures on both sides.

The current financial difficulties in the NHS tipped the balance in our favour.

To set up the organisation and register with Companies House we needed legal advice. It cost about £35,000, including employing the legal firm as company secretary. In future years we plan to have this role in house. We funded this through freed-up resources gained over the first couple of years of our consortium’s work.

We went for a particular type of social enterprise structure, the Industrial Provident Society. It’s a community-based organisation where all practices are members, which suits our egalitarian, inclusive commissioning ethos.

We had to hold our first AGM where we needed a quorum to vote for board members. Trying to get GPs to leave their surgeries was a challenge – the old line about herding cats comes to mind – so we made it clear the project couldn’t go forward without that commitment. Then it was hard work to get people to fill in the membership forms the right way. It’s something that inevitably goes to the bottom of the ‘to do’ list in a busy surgery – even my own practice managed to fill in the forms wrong! But we got there in the end, with a lot of chasing and support from PCT staff.

Nowadays there’s a lot more help available for people who want to go down the same route, from the Department of Health social enterprise support unit to the legal firms who specialise in this area.

How it works

We are a membership organisation where the number of members each practice has is proportionate to list size. The member could be a GP, nurse or practice manager.

I’m the chair and one of five GPs on the board. We also have five practice managers and one lay member on the board. All our GP leads have specific roles such as long-term conditions, finance and contracting, and we bring in expertise in specific clinical areas as needed. Each practice manager board member is linked to a GP lead.

There are quarterly meetings to which any staff member can come, which focus on clinical issues and service redesign. We usually have representatives from each practice and the relevant clinical leads.

As chair, I visit all the practices regularly to monitor performance and talk about PBC. It’s very much bottom-up, not top-down – peer pressure is important. Comparative data helps GPs know how they are doing and helps everyone feel they are all in this together.

We don’t provide services – we are about commissioning. Once we’ve identified a need and developed a patient pathway, we create a service specification. Procurement is handled separately by the PCT’s business case approval process. The aim is to get business cases approved within eight weeks.

Cultural change

At first the new PCT was largely paying lip-service to PBC – we had to win hearts and minds. It’s always tricky for people to give up power but there has been a big cultural change and we are now working much more closely together.

Relationships between the PBC group and PCT have developed as we’ve spent time together. We both now understand the two worlds we work in – so when we refer, we have an idea what the options are and what they cost, and the PCT understands how GPs work. There is better connectivity between the contracting and financial world of the PCT and the ‘coalface ‘ of general practice.

There’s a real sense of joint ownership. The financial pressures have really concentrated minds and the PCT realises PBC is part of the solution, not the problem.

Day to day

We have a service-level agreement with the PCT covering processes and responsibilities. Some 16 PCT staff are seconded to us to provide data, contracts and finance support. We have a management budget of £150,000 for cover for board members and clinical leads – I spend four sessions a week working for the company, and the other board members are covered for one session each.

The amount of work continues to grow – it often feels as if every piece of paper the PCT conjures crosses my desk. Board members and clinical leads complete timesheets so we can demonstrate the scale of work involved.

Our clinical leads for areas such as diabetes and COPD go into the PCT regularly and look at activity and other data, as well as providing feedback to the PCT, practices and the regular business meeting. Practice managers meet PCT teams and PCT staff go into practices to support them with prescribing and with using data.

The three chairs of each local PBC consortium attend PCT board meetings – we are guests rather than board members but it is clear the PCT takes us very seriously.

We have an overall devolved budget of £1m, which includes money for the local incentive schemes. These include peer review of referrals, prescribing targets and attending quarterly meetings.

New services
We’ve commissioned the ScriptSwitch prescribing management system. It sits on the practice computer and flags up expensive drugs, hospital-prescribed drugs and provides alternatives. For example some generics are now more expensive than non-generic preparations and this is flagged and can be changed with one click.

When we started out, there was a lot of frustration about growing demand from nursing homes and patients being discharged from hospital with little information. Now we’ve commissioned a team of a consultant geriatrician plus two GPs with nursing support, who go into nursing homes and actively manage patients. We are seeing a considerable reduction in home visits and admissions– in some cases visits have reduced by 50%. It was a hard slog, taking two years from idea to launch because of PCT reorganisation, but is now making a real difference.

We’ve also commissioned a minor surgery service. We found there were 1,700 procedures a year where patients were going into hospital for simple things such as removal of sebaceous cysts. Now there are three GP surgeons who carry out minor surgery in the community. Patients are very pleased that they don’t have to wait for ages and pay to park.

The future
We are currently working on ideas about commissioning better anticoagulation, ENT and phlebotomy services. The first is still based in outpatients, where people wait for hours (at an expensive tariff) for something that should be done more economically in the community.

One of the big performance issues is in orthopaedics, where the 18-week waiting time target is being breached and work is being sent out to the private sector at above tariff rates. We have drawn up a specification for a new service and are currently waiting for business cases to come in. Forming our company has been hard work but rewarding and has given ‘shop-floor’ general practice the chance to work in the macro world of the NHS.

Dr Bill Tamkin is chair of Manchester Practice-Based Commissioning (South) Ltd

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Aetna UK

Posted on November 11, 2009. Filed under: Commissioner, Social enterprise | Tags: , , , |

Aetna UK | accessed 11 November 2009

Aetna UK is dedicated to supporting PCTs and other commissioning authorities to improve patient outcomes and reduce overall costs. Aetna UK combines UK-based operations with U.S. expertise in order to customize solutions for its clients.

Being ‘commissioners’ ourselves, we truly understand what it takes to maximise health gain within available resources. We bring significant breadth and depth of experience from the U.S. and are well-positioned to deliver a differentiated perspective.

Aetna UK is part of an on-going expansion of Aetna’s international businesses, with London serving as the operations centre for both commissioning services and Aetna’s UK, Europe, Middle East and Africa expatriate business. 

Vincent Sai is Vice President and Managing Director of Aetna UK and is based in our London offices. Meet the Aetna UK Management team

Aetna Corporate Overview

Established in 1853, Aetna has been a trusted name in American healthcare for over 150 years. Integrity, reliability, and commitment are key to everything that we do. We are experienced in commissioning services and offer a broad range of health management services and health insurance products.

We have relationships and contracts with more than 783,000 healthcare professionals and facilities in the US. Globally, we have relationships with over 740 facilities, including 90 in the UK.

Our clients include public sector and government sponsored programmes, employer groups and individuals. Consistently, surveys recognise us as one of the most ‘doctor-friendly’ healthcare companies.

Partnership is key to our success. We work with some of the most complex organisations in the world today and believe that success can only come by working alongside our clients in order to create customised, practical solutions to solve their healthcare needs.

For more information, visit www.aetna.com .

The Aetna Way

At Aetna we put the people who use our products and services at the centre of everything we do and live by a core set of values.

aetnaway

Customer Profiles

NHS South Birmingham

NHS South Birmingham and Aetna have entered a partnership — the first of its kind, to redefine how healthcare is delivered in South Birmingham. This unique public-private partnership brings together expertise from two world-class organisations that will share best practices to implement innovative programmes and services for the benefit of patients in South Birmingham. We are calling the partnership “Out in From Together” which sets the tone and direction for how we want to work — partnering to lead the way to improve health and health services in South Birmingham. Read our Q&A to learn more about the partnership and key areas of delivery. For more information about NHS South Birmingham, visithttp://www.southbirminghampct.nhs.uk/.

PUBLIC-PRIVATE PARTNERSHIP REVEALS INNOVATIVE APPROACHES TO IMPROVING HEALTH OUTCOMES

LONDON | 8 September 2009

NHS South Birmingham and Pathfinder Healthcare Developments launch two pioneering services to tackle urgent health needs and risks

NHS South Birmingham and Pathfinder Healthcare Developments CIC (PHD cic) have partnered with Aetna Health Services UK to develop new ways of working to improve health outcomes in their respective communities. These two partnerships demonstrate how public and private entities can successfully work together, and have resulted in the launch of two new services that support each organisation’s larger strategic initiatives.

The first service, a telephone care management programme, is a nurse support service designed to help patients manage their long term health conditions. The second, an online health risk assessment tool, gives people a picture into their current and future health status, and provides them with an achievable action plan to address their greatest health risks. Both provide the National Health Service (NHS) and General Practitioners with innovative approaches to managing health care costs while improving quality through personalised care and support.

NHS South Birmingham and Aetna have teamed together to redefine health care delivery in South Birmingham. NHS South Birmingham is transforming the way health care is delivered to their local population and developing skill sets that have a positive and long-term effect on the population’s health.

“This is an exciting opportunity to learn from a company who has proven expertise in delivering quality services, effectively targeting and engaging individuals and, importantly, managing cost to improve patient experience and give them more choice around health services and their individual care,” said Moira Dumma, Chief Executive, NHS South Birmingham. “This requires collaboration across all stakeholders, and our unique partnership with Aetna unlocks the potential within the health economy to share best practices, improve commissioning expertise and engage the entirety of our population, including those most in need.”

Pathfinder Healthcare Developments (PHD) is a community interest company operating as a social business. PHD has grown from an innovative partnership between three large inner city GP practices based in the Sandwell area. Their work with Aetna supports a larger project to implement innovative new practices, services and ways of working to support their diverse patient populations and the quality of primary health care services.

“Aetna’s bespoke approach to working is what is most appealing,” said Dr Niti Pall, Chair, PHD. “There was no ‘off-the-shelf’ solution that they tried to implement. Rather, they listened to our needs, worked with us to devise solutions and areas of support, and most importantly, co-develop solutions that were appropriately translated for the British market.”

Having both a primary care trust and social enterprise company engage Aetna demonstrates Aetna’s ability to work with different types of organisations, and how best practices from the private sector can be successfully translated to the public sector. It also points to a shift in the way primary care trusts and providers are thinking about delivering additional health services—and how they can jointly address the needs of their populations by utilising the experience of the private sector.

As one of the leading diversified health care benefits companies in the U.S., Aetna has been recognised for its advancements in medical management and health information technology. Recently, the company has embarked on exporting these innovations to support health care reform across the globe.

Notes to editors:

1. The online health risk assessment tool is one of the most comprehensive on the market available to the general public. Upon completing a questionnaire about health and lifestyle habits, the tool will generate a risk score. An action plan is also automatically generated that includes suggestions on how to address current health conditions and also reduce or even prevent future ones. Additionally, the tool offers “healthy living programmes” that can be taken online to address individuals’ immediate health needs. Among the included programmes are “Stress Relief,” “Get in Shape,” “Cancer Fighting” and “Healthier Diet.” South Birmingham residents can access South Birmingham’s bespoke tool by registering on http://www.sbpct.nhs.uk; Patients of Smethwick, Hollybush and Cape Hill Medical Centres can access the online tool on http://www.smethwickmc.co.uk/.

2. Over 17.5 million people in the UK have a long term condition (Improving Chronic Disease Management. Accessed December 4, 2008 athttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214), 45% of which who suffer from more than one. For patients with more than one long term condition, health care costs are six times higher (DeVol R, Bedroussian A. An unhealthy America: The economic burden of chronic disease.The Milken Institute. Oct 2007.). 80% of GP visits relate to long-term conditions. The steep rise in diagnoses of long term conditions and increasing costs for providing care for these patients are forcing a change in the way that commissioners and GPs provide health services in such a way to help manage rising costs while still providing excellent and quality services.

3. Aetna’s care management programme is a telephone-based support service for patients who have two or more long term conditions. Delivered by registered nurses, the service provides patients with additional support to help change their health outcomes by changing their health behaviours. Powered by Aetna’s leading data analytics and informatics tools and backed by an experienced clinical team trained in motivational interviewing techniques to deliver highly personalised care, the service aims to close the care gap by connecting patients to resources to support their journey to a healthier lifestyle.

4. Aetna is a leading health care company, commissioning services for approximately 37.2 million people worldwide through a broad range of health management services and health insurance products. Aetna has relationships with more than 1.3 million health care professionals around the globe, demonstrating the company’s commitment to providing customers and individuals with access to safe, affordable, high-quality health care. Building on its more than 150-year history, Aetna is recognised for its dedication to cooperating with doctors and hospitals, employers, patients, public officials and others to build a stronger, more effective health care system.

5. Aetna UK was established in early 2007 to offer dedicated commissioning support services to Primary Care Trusts (PCTs), and was appointed to the Framework for procuring External Support for Commissioners (FESC) later that year. In 2008 Aetna was appointed to the Practice Based Commissioning (PBC) Development Framework to provide support for PCTs and PBCs to help them strengthen and build on local support arrangements for practice based commissioning. www.aetna-uk.co.uk

6. NHS South Birmingham commissions services for a population of 383,000 people. Currently our Primary Care Services include 65 GP practices, 170 General Dental Practitioners, 71 community Pharmacies, and 80 local optician premises including domiciliary services. We try to keep health care close to home and offer a range of nursing and therapy services to support this through your local GP. We look at the health of the entire local population and address issues specific to our area. Public health is an important role and includes issues such as poverty, obesity, diet, exercise, smoking and other factors which impact on your health. www.sbpct.nhs.uk

7. Pathfinder Healthcare Developments (PHD) is a Community Interest Company (cic) based in the West Midlands concentrated in the Sandwell area. PHD is a progressive and innovative provider of extended primary care services, specialising in meeting the needs of inner city multiracial populations. It currently provides a wide range of services to a population of just over 25,000 across three practices and three sites through a Personal Medical Services (PMS+) contract and an Additional Personal Medical Services (APMS) contract with PCTs. It has a track record of delivering high quality services, often leading the way locally in the development of services, particularly to marginalised groups. PHD has a track record of excellence (recognised by the UK Department of Health) often leading the way in the development of services, particularly to ethnic minority communities, and to marginalised groups. The UK Department of Health has recognised the standards we achieve and the innovation we apply. www.path-finderhd.com

AETNA APPOINTED BY DEPARTMENT OF HEALTH TO THE PBC DEVELOPMENT FRAMEWORK

London | 2 December 2008

Appointment brings together expertise of Aetna, PricewaterhouseCoopers and the Royal College of General Practitioners

Aetna (NYSE: AET) announced today that it has been appointed by the Department of Health as one of five suppliers on the Practice Based Commissioners (PBC) Development Framework.  The goal of the Framework is to promote excellence in practice based commissioning by supporting the development of core competencies within PBCs and Primary Care Trusts (PCTs).

“Practice based commissioning is a critical element to achieving world class commissioning aspirations.  We are delighted to be recognised as a leading player in such an important area,” said Vincent Sai, Vice President and Managing Director of Aetna UK.

Recognising there is no “one size fits all” solution, Aetna will team up with PricewaterhouseCoopers and the Royal College of General Practitioners (RCGP) to deliver development services.  The breadth and depth of this relationship combines the perspectives of one of the world’s largest commissioning organisations and health analytic experts; one of the world’s leading change management and organisational development consultancies; and clinical insight and leadership from the largest of the Royal Colleges. 

“The unique combination of skills of Aetna, PricewaterhouseCoopers and the RCGP also reflect Aetna’s commitment to bring the best resources to support PBC development and foster continued improvement and innovation within the NHS,” continued Mr Sai.

Services offered range from building analytic and commissioning skills, organisational and leadership development, to improved engagement of key stakeholders including clinicians, patients and the public.  Ultimately, the value that the partnership brings is its experience in creating bespoke solutions that can help PBC consortia prioritise and develop foundational capabilities for sustained success.

END

Notes to Editors:
1. Aetna UK will partner with PricewaterhouseCoopers and the Royal College of General Practitioners to provide support for PCTs and PBCs to help them strengthen and build on local support arrangements for practice based commissioning.

2. Aetna is a leading healthcare company, commissioning services for approximately 37.2 million people worldwide through a broad range of health management services and health insurance products. Aetna has relationships with more than 1.3 million healthcare professionals around the globe, demonstrating the company’s commitment to providing customers and individuals with access to safe, affordable, high-quality healthcare. Building on its more than 150-year history, Aetna is recognised for its dedication to cooperating with doctors and hospitals, employers, patients, public officials and others to build a stronger, more effective healthcare system. Aetna UK was established in 2007 to offer dedicated commissioning support services to Primary Care Trusts (PCTs). As one of only six U.S.-based suppliers selected to provide advisory and commissioning services, Aetna UK is approved by the Department of Health through its sponsored Framework for procuring External Support for Commissioners (FESC). www.aetna-uk.co.uk

3. PricewaterhouseCoopers has an extensive track record going back over 30 years of providing authoritative advice and assistance to a wide range of public and private health organisations, including the Department of Health and other government departments, SHAs, commissioners and providers. PricewaterhouseCoopers also works in collaboration with other key stakeholders such as Monitor, the NHS Confederation, and quality regulators, such as the Royal Colleges and the Audit Commission, to add insight and expertise in key areas of policy and delivery. www.pwc.co.uk

4. The Royal College of General Practitioners (RCGP) is the academic organisation in the UK for general practitioners. Its aim is to encourage and maintain the highest standards of general medical practice and act as the ‘voice’ of general practitioners on education, training and standards issues. Founded in 1952, the RCGP is a relatively young organisation with an outstanding record of achievement. Milestones in its history include the establishment of vocational training in general practice, the setting up of clinical guidelines for doctors, the expansion of research into general medicine practice and the promotion of primary care. www.rcgp.org.uk

Aetna Positioned to Expand in England: Appointed by Department of Health to the ”Framework for Procuring External Support for Commissioners” (FESC)
–Aetna to offer range of services to support Primary Care Trusts–

HARTFORD, Conn | BUSINESS WIRE | 5 October 2007

Aetna (NYSE: AET) announced today that it has been appointed by the Department of Health as one of the suppliers on the Framework for Procuring External Support for Commissioners (FESC) to offer commissioning support to Primary Care Trusts (PCTs) in England. The FESC will provide PCTs with easy access to a framework of expert suppliers who can support them in undertaking their commissioning work.

The NHS provides health care coverage for all citizens in England, based on need, not ability to pay. It is the largest organization in Europe and one of the largest employers in the world, with more than 1.3 million employees. Originally created in 2002, PCTs are free-standing local organizations within the NHS responsible for ensuring that community health needs are met. In consultation with community stakeholders, PCTs develop health care plans that best meet the needs of their individual patient populations and commission services with providers.

Services that Aetna will offer to local PCT managers include a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services.

“We are very pleased to have been selected as a supplier on the framework by the Department of Health in England,” said Ronald A. Williams, Aetna chairman and CEO. “We believe we have a range of skills that complement existing experience within Primary Care Trusts, and are excited to be given the opportunity to help to strengthen health care delivery in communities across England.”

Aetna’s proven experience in managing health care quality and cost to a budget through effective contracting and procurement techniques, information analysis and its partnership approach to program design were key components of the company’s successful appointment as a supplier for the FESC.

According to Martha Temple, vice president of Aetna with primary responsibility for the company’s international businesses, “Our goal is to form partnerships to create integrated solutions that address the differing health challenges and health needs of PCTs across England. We will do this in a way that truly addresses the top concerns of both PCTs and patients.”

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 34.9 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, medical management capabilities, and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans in both the U.S. and internationally. Aetna’s international businesses also include Aetna Global Benefits(R), Aetna’s expatriate benefits division that focuses on providing comprehensive benefit solutions to employees working, travelling and living in over 100 countries. http://www.aetna.com

CONTACT: Media Contact:
Aetna
Katherine Lee Balsamo, 860-273-2707
BalsamoK@aetna.com

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Zitron: scrap PCTs and cut bureaucracy

Posted on November 5, 2009. Filed under: News stories | Tags: |

Health Service Journal | By Steve Ford | 5 November 2009

The chair of a London primary care trust has proposed scrapping PCTs. He said giving their commissioning role to local authorities would be an “excellent” way of reducing bureaucracy and bringing health services closer to the public.

NHS Hammersmith and Fulham chair Jeff Zitron said in London local commissioning could be done by councils and acute commissioning through a capital-wide body. The “same principle” should be applied elsewhere in England. He told HSJ: “Not only does London not need 31 PCTs, I don’t think it needs any at all.”

Outside the capital, “local commissioning ought to be more local and more accountable and central commissioning ofacute care done in bigger units”, he said.

Scrapping PCTs in London would save £2.5m on non-executive directors, he added.

NHS Hammersmith and Fulham is one of just two PCTs to share a chief executive with the council. Herefordshire council and PCT were the first, and Waltham Forest council and PCT are attempting to merge senior management positions.

His comments follow an article for HSJ’s sister title Local Government Chronicle, in which he wrote that council commissioning health services would “strip out a layer of administration and bring health services even closer to the public.”

Joint chiefs were the obvious way forward

Local Government Chronicle | 5 November 2009

NHS Hammersmith & Fulham is responsible for the health of more than 170,000 residents, including the inmates of HMP Wormwood Scrubs. Our job is to promote healthy lifestyles and to commission services from hundreds of NHS and independent providers. 

We spend a third of a billion pounds a year, and employ around 160 staff. When I became chair in December 2007 I quickly saw that, despite largely good performance scores, we would struggle to be fit for purpose in the future. 

That is no reflection on our excellent staff team; it is about three things: first, we are responsible for health promotion but have few direct means of influencing behaviour.

Second, we are a complex organisation – in staffing, contracting, data management, ICT and more – but rely on small teams and risk ever-rising overheads.

Third, and most important of all, many of our goals – particularly in addressing health inequalities – target the same people as the council’s work in social care, housing, education or leisure.

But council colleagues have far more day-to-day contact with residents than do most NHS people.

Our track record of joint working was excellent but lacked the bite of focused leadership and accountability. Integration of the executive leadership seemed the obvious way forward.

Fortunately, the right people were in the right place.

Geoff Alltimes and Sarah Whiting are outstanding leaders, willing to take the personal risk of radical action. Both organisations attract high-calibre, creative staff who relish a challenge.

Leadership integration is here to stay in Hammersmith & Fulham. If our model works, government might decide that local health commissioning should transfer to councils and PCTs merge or be scrapped.

That, in my view, would be an excellent result, stripping out a layer of administration and bringing health services even closer to the public.

Jeff Zitron, chairman of NHS Hammersmith & Fulham

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London health integration plan on the table

Posted on September 10, 2009. Filed under: News stories | Tags: |

Health Service Journal | BY JAMES ILLMAN | 10 September 2009

London’s boroughs are on the verge of sealing a deal to dramatically boost integration between councils and the NHS, Local Government Chronicle has learned.

Plans for a “health integration board” of 15 councils and their respective primary care trusts are being finalised by London Councils and NHS London in a bid to stimulate better joint working, as public sector bodies move to slash costs and improve services. 

Barking and Dagenham council chief executive Rob Whiteman, who chairs the chief executives’ London committee and has been involved in setting up the board, said he expected the new body to have 12 to 15 members, including PCT and council chiefs.  

“We have identified 15 local authorities who are interested in integration with their PCTs to differing degrees. They recognise there needs to be a lot more shared posts and joint commissioning,” Mr Whiteman said. 

Plans were originally worked up at an event in July hosted by NHS London chief executive Ruth Carnall and Mr Whiteman with details of who is on the board and which boroughs are involved expected to be finalised later this month.

It is also hoped the new venture will be able to learn from Hammersmith and Fulham council, which moved to a joint management structure with its PCT in April. Council chief executive Geoff Alltimes now has a dual role.

The borough became only the second council in England and Wales after Herefordshire Council to share its chief executive with a PCT and Jeff Zitron, chairman of Hammersmith and Fulham Primary Care Trust, said the arrangements were working well.

Joined-up working across the PCT and the council will make services a lot more user friendly for residents and the new model fits with health secretary Andy Burnham’s call to “make every visit count”, Mr Zitron said.

He said he did not anticipate conflicts of interest arising as a result of having a joint management structure.

“What we are talking about is unified leadership at executive level. The PCT is still part of the national health service, is answerable to the secretary of state and has both national and London responsibilities. The council knows and respects this,” he said.    

London Councils chief executive John O’Brien said: “From a London Councils perspective, we also think that such collaboration is consistent with our aspiration to move towards greater democratic influence over the commissioning of a wider range of local public services.”

Wigan chief executive Joyce Redfearn, who chairs the Local Government Association’s chief executives task group, welcomed the plans.

“We are talking about these sorts of ideas in Greater Manchester, although we are not as far down the track. A lot of places will be looking at this sort of thing,” she said.  

From Local Government Chronicle.

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GPs could hand commissioning to private firms under Tories

Posted on July 17, 2009. Filed under: Journals | Tags: , |

Health Service Journal | By Helen Crump | 16 July 2009

GPs could be given the opportunity to bypass primary care trusts and hand commissioning to private sector organisations under Conservative plans. 1204591_blood_pressure_GP

Shadow health minister Mark Simmonds told HSJ that using companies such as Humana would be an option where GPs did not want to become commissioners.

The Conservatives have pledged to give GPs real commissioning budgets – the practice based commissioning system does not allow this.

Mr Simmonds acknowledged some GPs would not want to take on commissioning work.

Primary care trusts’ expertise might be called on in these situations. “There may also be circumstances where if there’s a continuing reluctance [from GPs] we may have to bring in others to commission on their behalf.”

“Federated” groups of GPs would be allowed to select whether another GP consortium, the PCT or a private firm did the commissioning, he said.

“We need to emancipate and empower GPs, and practice based commissioning doesn’t deliver.”

Mr Simmonds said commissioners would be paid to hit targets under an expanded quality and outcomes framework encompassing preventive measures.

But he would not say whether PCTs would be downsized as a result of moving some commissioning work into primary care. “That’s part of the discussion and decisions we need to make about where resources are allocated.”

Mr Simmonds called for a “greater aligning of incentives” between GPs, pharmacists, nurses and primary care trusts – including using the quality and outcomes framework.

He said: “We need much more effective commissioning and that means we have to have commissioning that is ultimately focused around driving improved patient outcomes.”

In order to avoid conflicts of interest he said GPs would be expected to use a “tendering process” to appoint providers.

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Take on more risk to increase share of health market, private companies told

Posted on June 12, 2009. Filed under: Journals | Tags: , , , |

Health Service Journal | BY HELEN CRUMP | 11 June 2009

Private companies must take on more risk if they want to gain a bigger share of the primary and community care market. Take on more risk to increase share of health market, private companies told

Harrow primary care trust chief executive and chair of the London PCTs’ commercial board Sarah Crowther said the perception within the health service had been for some time that risk sharing had been working in favour of the independent sector.

She said: “Perhaps what [independent sector providers] need to think about for the next period of time is how do you incentivise PCTs to change some of their provider relationships, to have the confidence to work with you.”

Ms Crowther, speaking at an NHS Confederation seminar, said the DH commercial directorate, which has been replaced by local commissioning support units, “hadn’t done the independent sector any favours” by negotiating costly deals which loaded risk back onto the NHS.

She said: “The days when it was all about how do you get the independent sector involved are gone. Actually what we’re interested in as commissioners is who is the right provider to give us the right deal to provide the right service.”

But she acknowledged not all PCTs would be taking the same approach to competition and co-operation.

“That may not be perfect, but it’s the reality. Get over it,” she said.

She advised independent providers to think about taking on projects that were not of optimum size in the first instance, in order to build a track record.

Linked to that, PCTs needed to get better at building relationships, she added.

And the private sector would need to tell commissioners how it was going to help them take capacity out of the health system.

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Exclusive: Half of PCTs use firms to help commission services

Posted on May 21, 2009. Filed under: FESC, News stories | Tags: , |

Healthcare Republic | 20 May 2009

More than half of PCTs used private companies or consultants to help commission services in 2008/9, a GP newspaper investigation has found.

In addition, a fifth of PCTs use private companies to develop, write or improve their strategic plans, the investigation shows.

Data obtained from 64 PCTs under the Freedom of Information Act show that they paid an average of £284,329 to private firms in 2008/9. PCTs used an average of four firms each to provide advice or support.

14 admitted a private firm was paid to write, develop or improve their annual or long-term strategic plans.

Some PCTs paid private firms huge sums for help. Birmingham East and North PCT paid data supplier Dr Foster more than £990,000 as part of a plan to cut health inequalities.

GP newspaper also found that two SHAs – NHS East of England and NHS North West – employed firms on behalf of PCTs to help develop their strategic plans.

In addition, PCTs are spending tens of thousands of pounds preparing themselves for the scrutiny of the DoH’s World Class Commissioning (WCC) panel. Five PCTs and one SHA – NHS North West – paid private firms to conduct mock interviews to prepare PCT board members for their WCC assessments.

The revelations come as an investigation by the Royal College of Nursing (RCN) found that the NHS spends £350m a year on management consultants, enough to expand the QOF by a third.

Dr David Jenner, practice-based commissioning lead at the NHS Alliance, said it may be effective for smaller PCTs to outsource highly-skilled work but PCTs should ‘be able to write their own plans’.

‘At a time like this we need co-operation, without paying for all the additional costs involved in the private sector, like their advertising.’

Dr Jenner said if a company’s contribution to a PCT’s strategy is not clear, it could be seen by the public as a form of deception.

The DoH approved 14 companies last year for PCTs to use under the Framework for procuring External Support for Commissioners (FESC).

Last year a handful of PCTs, including NHS Northampton and NHS Wigan, announced multi-million pound deals with private firms under the framework.

tom.ireland@haymarket.com

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Practice win integrated health awards from Prince Charles

Posted on May 21, 2009. Filed under: Integrated care, News stories | Tags: , |

Healthcare Republic | 20-May-09

Winners of the new NHS category of Prince Charles’s Integrated Health Awards have received presentations from the royal.

The winner of the GP practice category was Patford House Surgery in Calne, Wiltshire, which devised an imaginative project to tackle childhood obesity through local primary schools.

It invited 200 Year 4 children to a Fun Fitness session in January and found that nearly one in four fell outside weight guidelines. This was followed by a 12-week programme. Parents take part in healthy eating sessions, there is even a Michelin-starred chef to advise on tasty dishes, while the children are simultaneously involved in fun physical activities.

The best practice-based commissioning group was STAHCOM, based in St Albans, Hertforshire, which provides a high-volume acupuncture service for osteoarthritis of the knee. Treating four at a time, most patients are 50-80 years old, some previously relying on physiotherapy and lifestyle advice but others facing knee surgery.

Only four out of 42 patients taking part needed to be re-referred for further treatment.

Dr Michael Dixon, The Prince’s Foundation for Integrated Health’s medical director, said: ‘Both these projects are wonderful examples of what integrated health really means – not just treating people when they are sick, but helping them keep as healthy as possible.’

neil.durham@haymarket.com

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Plan to boost NHS purchasing power

Posted on May 12, 2009. Filed under: News stories | Tags: , , , |

 

Financial Times | By Nicholas Timmins, Public Policy Editor | 8 May 2009

New commercial arrangements for the NHS, aimed at boosting the ability of primary care trusts to commission services from the private and voluntary sectors and beefing up the NHS’s buying power, were announced on Thursday.

The NHS Purchasing and Supply Agency, which handles about £11bn ($17bn) of NHS business a year, will be broken up. Some £20m will be spent on setting up regional units to provide commercial and market development support to the 152 primary care trusts that buy care on behalf of patients. Several activities, such as buying energy and vehicles, will be transferred to the Office of Government Commerce.

The NHS has signed a 10-year deal with DHL to run a big part of its supply chain.

The department’s private finance unit, which handles PFIs and PPPs, and the remainder of its commercial directorate will be merged.

The NHS, which faces a fierce budgetary squeeze once the government starts to pay for borrowing it has taken on, must get maximum value for money out of the billions of pounds a year it spends on goods and services, said Mark Britnell, the health department’s director-general of commissioning.

Primary care trusts were being encouraged to become commissioners of care but it was “neither possible nor desirable” for all 152 to develop the contract management and procurement skills needed without working with others, he said.

Mike Parish, chairman of the NHS Partners Network, which represents private sector providers of NHS care, said: “This is the right approach, both pragmatically and philosophically.” But he warned that “the proof will come in how effectively these changes are put in place”.

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NHS chiefs plan to speed up privatisation in primary care

Posted on April 17, 2009. Filed under: News stories, Providers | Tags: , , , , , |

Pulse | By Gareth Iacobucci | 9 March 2009

PCTs are set to dramatically ramp up efforts to entice the private sector into primary care after failing to meet Government targets to increase competition.

A series of detailed SHA assessments of PCTs commissioning skills found they had not gone far enough to open up the primary care market.

Reports carried out under the Government’s World Class Commissioning scheme show even trusts that have embraced APMS have failed to achieve above average scores, which is set to lead to a renewed drive to meet future targets.

The NHS Confederation said it expected many PCT-run surgeries to be farmed out to APMS, as trusts look to entice private providers to run GP services.

The reports, many of which marked PCTs down from their self-assessments, offer detailed advice on how trusts can stimulate the market by next year’s assessment.

NHS Berkshire West was marked down on two of the three categories for stimulating the market, and advised to ‘encompass a wider range of services provider’.

NHS Suffolk, which scored level one, the lowest score, on all aspects of stimulating the market was advised to ‘continue building on its active approach to tendering’.

Even Camden PCT, which handed three practices to US healthcare giant UnitedHealth last year, was marked down to level one on all three categories for stimulating the market.

David Stout, director of the NHS Confederation’s PCT Network, said it was unsurprising to see PCTs struggling as the market was ‘very new for the NHS’.

He said: ‘[The indicator] is asking, “Are there concerns about quality, and are there alternative providers who could add something?”. If there are, how do you encourage them to participate?’

Mr Stout said while he didn’t necessarily envisage an immediate expansion of APMS, he did expect many PCT-run services and any new contracts to be tendered.

He said: ‘Where APMS will be used is where new services will be commissioned. From a competition point of view, you’d be hard pressed not to use APMS.’

But Dr Chaand Nagpaul, GPC negotiator with responsibility for commissioning, said the drive to increase competition had ‘nothing to do with improving healthcare’.

‘This highlights how PCTs can be diverted into pursuing meaningless political targets rather than supporting and developing existing GP practices.’

A Department of Health spokesperson said: ‘PCTs are expected to stimulate and shape the market including a number of providers from voluntary, NHS, private, local government sectors and others.’

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HSJ commissioning supplement: An in-depth look at FESC

Posted on April 16, 2009. Filed under: FESC, Journals | Tags: , |

Health Services Journal | BY HELEN MOONEY | 1 NOVEMBER, 2007 

The Framework for procuring External Support for Commissioners has finally arrived. Launched by the Department of Health at the start of last month after several delays, the government hopes that the framework will usher in a change in the shape and strength of commissioning in the NHS.

fesc1The DoH’s commercial directorate has picked 14 private sector companies to appear on the framework list, which it hopes will be used by primary care trusts to help them in their commissioning role.

Seven organisations have already started down the road of using FESC, with some at the early stage, drafting a business plan for use of the private sector before consulting the board and other stakeholders.

Others, namely London’s Hillingdon PCT, are further advanced. The organisation has already picked BUPA Commissioning as preferred bidder to help it manage and analyse more effectively the contracts it holds with its acute sector providers.

The results from HSJ’s survey of 93 chief executives, commissioning directors, finance directors and others from a total of 74 PCTs about their views on FESC make for interesting reading. Four in five thought there were ways other than FESC to help the commissioning process at PCT level, and nearly half thought that the framework would prove only ‘a little’ successful within their organisations.

And although the PCTs were fairly confident – 61 per cent of respondents – that their uptake of the use of the FESC would not be performance managed by their strategic health authority, almost all respondents said that their SHA would be performance managing them on the quality and effectiveness of their commissioning.

This HSJ Commissioning Supplement is an attempt to gauge the view of commissioners and performance managers on FESC. It analyses the government’s reasons for introducing such a framework and asks how it might work.

DoH director general of commissioning and system management Mark Britnell explains how FESC forms part of the wider push for World Class Commissioning.

We also look at how the seven organisations selected to pilot FESC intend to go forward and what they are likely to use the framework for.

It remains to be seen how FESC will be used and how the private sector-PCT relationship will evolve. A best case scenario is that PCTs recognise what commissioning help they need and use the FESC and those private sector companies on it to provide real, intelligent commissioning expertise which remains within those organisations long after the private companies have departed.

It is clear that many PCTs are failing at present to manage the job on their own and, as Hillingdon PCT’s chief executive Professor Yi Mien Koh says, the private sector could well provide the ‘quick injection’ of expertise needed to make the commissioning process work in a landscape of payment by results, tariff, and an increasing number of semi-autonomous foundation trusts.

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