Guide for World Class Commissioners

Posted on January 8, 2010. Filed under: Reports/papers | Tags: |

Promoting Health and Well-Being: Reducing Inequalities

Royal Society for Public Health | accessed 8 January 2010

To improve the health of local populations requires World Class Commissioning that is relevant, sensitive and accessible. This Guide has been developed by the Royal Society for Public Health in partnership with the National Social Marketing Centre, with funding from the English Department of Health. It will assist Commissioners to make the most of the best methods of promoting health, using the latest understanding of how we can support people to make healthy choices as individuals within the social and environmental contexts in which they live. The Guide will also be of value to Providers in giving insight into the Commissioning process.

“This Guide will help people do good work more efficiently and will prevent a waste of resources, I strongly recommend Primary Care Trusts should not take action without reading the Guide first.”

Sir Muir Gray, Director of the National Knowledge Service.

To download click here

If  you have any questions please don’t hestitate to contact Richard Shircore or call 020 3177 1622

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Focus on… becoming a provider

Posted on December 8, 2009. Filed under: News stories | Tags: , |

Pulse | Practical Commissioning | 8 December 2009

Michelle Webster and Beverley Slater of the Improvement Foundation set the context for those looking to provide their own services

Providing health services to patients within a small business model is what GP practices do all the time. So becoming a provider may seem a natural progression for enterprising GPs, keen to take advantage of additional service needs that have been identified.

But, as the articles in this section make clear, setting up a provider company is not for the fainthearted; it is riskier and as complex as setting up a PBC consortium. Establishing good governance processes, securing the NHS pension status of staff, identifying and raising an appropriate amount of start-up capital, learning how to respond to a tender and deciding what legal form of company to adopt are just some of the time-consuming obstacles described.

But what the articles also provide is valuable advice from those who have successfully negotiated this minefield of potential difficulties and emerged with their enthusiasm intact. The progress of Vale Health, from running pulmonary rehabilitation services in 2006 to being a partner in a successful £30m urgent care contract in 2009 and Horizon Health Choices’ progress from £70,000 turnover in 2007/8 to an estimated £1m in 2009/10 are testament to the talent and persistence of those involved.

Although the issue of conflict of interest is repeatedly cited when GPs operate as both commissioners and providers, as these case studies demonstrate, providing that there are clear processes in place to ensure fairness and equity when PCTs procure services and award contracts, all parties can be assured that there is an effective commissioning process through which the right provider can be chosen. Establishing a relationship with the PCT that works for both parties and ensures openness and transparency is therefore an important task for GP-led provider companies.

The range of services described in the case studies goes beyond the early Care Closer to Home initiatives identified by PBC. In addition to community gynaecology clinics, pulmonary rehabilitation and musculoskeletal services, the companies have extended to deliver psychological therapies, chronic pain services, an extensive urgent care service and health checks for hard-to-reach groups. New service models and patient population groups are being addressed by these two pioneering provider companies as they seek to develop services in response to patient need, while making their businesses more efficient by using existing infrastructure to deliver a wider range of services.

Those who set up as providers may do so for a range of motivations, as discussed in the interviews with leaders in this area (page 28). But it is also important to remember that PCT commissioners will have their own reasons for encouraging, and helping, new providers to enter the market. World-Class Commissioning competency 7 demands that ‘world-class commissioners effectively stimulate the market to meet demand and secure required clinical, and health and wellbeing outcomes’.

In order to do this, PCT commissioners have to work with potential providers from all sectors, including primary care, the third sector and the private sector, to enable a greater choice of providers able to respond to the changing needs of the local population. However, cutting across this requirement has been the recent statement by health secretary Andy Burnham that the NHS is the ‘preferred provider’. It remains to be clarified whether PBC provider organisations are seen as part of NHS ‘preferred provider’ family – or indeed what the wider implications of this new policy emphasis will be.

Provider companies will need to keep a close eye on the promised policy updates in this developing area.

Michelle Webster is national commissioning lead and Beverley Slater is national knowledge management lead for the Improvement Foundation

Go to

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Integrated Care Network – An Introductory Guide

Posted on October 26, 2009. Filed under: Integrated care, Reports/papers | Tags: , |

Department of Health | accessed 26 October 2009 (pdf)

The programme of Integrated Care Pilots (ICP) is a two-year Department of Health (DH) initiative. Its purpose is to explore different ways of providing health and social care services to

help drive improvements in local health and wellbeing.

The programme of Integrated Care Pilots (ICP) is a two-year Department of Health (DH) initiative. Its purpose is to explore different ways of providing health and social care services to help drive improvements in local health and wellbeing.

Integrated care is an important building block within the strategic plan for improving the health and wellbeing of the population of England, as highlighted in both the NHS Next Stage Review report High Quality Care for All and the concordat Putting People First. Both documents stress the importance of improving local health and care services by offering personalised, flexible and high quality services, where the individual is at the centre and engaged in service organisation. Integration may refer to partnerships, systems and models as well as organisations; crossing boundaries between primary, community, secondary and social care.

Each of the 16 pilot sites participating in the national programme has developed an integrated model of care to help respond to particular local needs. Using their in-depth knowledge of the local population, the pilots are designing services that should be flexible, personalised and seamless.

The ICP programme is one of a number of initiatives looking to deliver these objectives. All pilots will be working with local organisations involved in world class commissioning (WCC) assurance Year 2, and participation in ICP should enable sites to demonstrate success against many of the competencies for WCC assurance.

The following pages provide summaries of the work each pilot will be doing over the next two years as they explore the potential and impact of their models, whilst identifying learning and best practice to be shared with others.

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World class commissioning – an introduction

Posted on October 15, 2009. Filed under: Reports/papers | Tags: |

Department of Health | Guidance | 15 October 2009

World class commissioning is about delivering better health and wellbeing for the population, improving health outcomes and reducing health inequalities. In partnership with local government, practice based commissioners and others, Primary Care Trusts (PCTs),supported by Strategic Health Authorities (SHAs), will lead the NHS in turning the world class commissioning vision into a reality, adding life to years and years to life.

This guide provides a brief introduction to world class commissioning.

Download World class commissioning an introduction (PDF, 303K)

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The NHS as preferred provider

Posted on October 13, 2009. Filed under: Reports/papers | Tags: , |

Department of Health | Dear Colleague Letter | 13 October 2009 

The Secretary of State’s recent speech at the King’s Fund focused on putting quality at the core of the NHS. He assured ‘the NHS is our preferred provider’. The attached letter shares with NHS Chief Executives how we propose to move this policy forward through the development of future guidance.

SHA Chief Executives
PCT Chief Executives

Gateway Reference Number: 12774
On the 17th September, the Secretary of State made a speech at the King’s Fund which focused on putting quality at the core of the NHS. He stated: With quality at its core, I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision. Let me begin with where I stand on this debate, and that is that the NHS is our preferred provider. But it is the important job of the commissioner to test whether these services provide best value and real quality.

Where a provider is not delivering quality – and the new accountability information will more readily demonstrate that – we will set out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers. This is fair to all as it means everyone knows where they stand and services stand or fall on the quality they provide.”

The purpose of this letter is to share with you how we propose to take this policy forward and highlight the potential implications for commissioners.

“The NHS as the preferred provider” is about getting the best care for patients and looking after the NHS staff who care for them. Our aim is to ensure that NHS staff are treated fairly and engaged in decisions, so that they know what is happening and when, what changes are being sought and why, and have a full opportunity to contribute to improving and re-designing the services that
they provide. Service improvement and re-design should not be something which is imposed on NHS staff but something which they own and lead.

We propose to do this – as the Secretary of State announced at the King’s Fund – “by setting out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers”. This will ensure “everyone knows where they stand and services stand or fall on the quality they provide”. In practical terms, we will provide guidance to PCTs on the processes we expect them to follow, which includes engaging with NHS organisations and their staff and trade union representatives, coupled with strengthened assurance processes.

“The NHS as the preferred provider” does not have implications for current or future ‘Right to Request’ proposals to set up social enterprises. We remain committed to supporting those PCT staff who wish to set up social enterprises, and neither Secretary of State’s letter, nor future guidance, should preclude the establishment of successful ‘Right to Request’ schemes. Application and assurance processes remain unchanged.

The Secretary of State has written to Brendan Barber, the General Secretary of the TUC, outlining the core principles he expects commissioners to follow from now when engaging with NHS providers. To illustrate these principles and how they might be developed in practice, we have developed six draft scenarios which set out the processes we expect PCTs to follow henceforth as commissioning needs arise (these are shown as an annex to the letter). These scenarios will inform the development of further guidance.

We will approach the development of guidance in two stages. Firstly we will publish guidance which will supersede Necessity – Not Nicety. Secondly, we will issue a revised PCT Procurement Guide and refined Principles and Rules of Co-operation and Competition. All key stakeholders will be invited to help shape these documents. Whilst we are preparing and publishing new guidance that will supersede Necessity – Not Nicety, we remain committed to the establishment of regional Commercial Support Units and the national Strategic Market Development Unit, which have important roles to play in supporting the development of World Class Commissioning (WCC).

In addition to the revised guidance, there will be implications for assurance processes, including for WCC and Transforming Community Services. It is too early to tell what these are likely to be but the WCC and TCS teams will work closely with the service, the SPF and stakeholders to identify and develop appropriate proposals that are robust and aligned existing assurance mechanisms. Our over-riding principle is to provide high quality care for patients delivered by providers who offer the best care. We remain committed to the participation of independent and third sector providers where this is the right model for patients – for example, where we need new services/service models, or substantial increases in capacity, or to offer increased choice to patients or to stimulate innovation.

We are committed to treating NHS staff fairly; giving NHS providers the opportunity to meet commissioner’s needs and thereby doing the best thing for NHS patients. For new or substantially redesigned services, PCTs would be expected to engage fully with the existing provider(s) and staff at an early stage, as well as other potential providers, enabling them to contribute to service specifications. Only after this would a decision on whether or not to openly tender take place. When competition is used it should be transparent, equal, fair and proportionate to deliver the best care to meet the needs of the local population.

I hope this helps to explain the concept of “the NHS as the preferred provider”, in advance of the proposed revised guidance. If you would like any further information, or clarification of the above, please do not hesitate to contact your SHA system management or commissioning director, or Claire Whittington (0113 254 5619), Sebastian Habibi (0207 633 7458) or Bob Ricketts (0207 633 4209/4210) at the Department.

David Nicholson CBE
NHS Chief Executive

1. Letter from SofS to Brendan Barber, General Secretary of the TUC

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Andy Burnham’s preferred bidder pledge questioned

Posted on September 24, 2009. Filed under: Journals, Providers | Tags: , , |

Health Service Journal | BY REBECCA EVANS | 24 September 2009

Questions have been raised over the implications for competition and world class commissioning of health secretary Andy Burnham’s statement that the NHS is the “preferred provider” of services.

Previous Department of Health policy had been that “any willing provider” should be considered when commissioningservices.

But in a speech last week at the King’s Fund, in whichMr Burnham stressed the importance of raising quality, he said: “The NHS is our preferred provider. But it is the important job of the commissioner to test whether these services provide best value and real quality.

“Where a provider is not delivering quality – and the new accountability information will more readily demonstrate that – we will set out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers.”

Answering questions after his speech, he said NHS providers should be given at least one opportunity to improve before commissioners went out to tender for an alternative provider.

Unison senior national officer for health Mike Jackson told HSJ the speech was significant: “I think now there’s clarity that the NHS is the preferred provider and there ought to be co-operation before competition.”

But Primary Care Trust Network director David Stout said the speech “would potentially cross over quite a number of the co-operation and competition panel principles”.

DH spokeswoman said: “The health secretary signalled the need to clarify policy and guidance to ensure that whilst putting quality of the heart of everything we do in the NHS, staff were treated fairly by being given an opportunity to improve performance and services before commissioners considered engaging with alternative providers.”

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World class commissioning: efficiency made a core competency

Posted on September 23, 2009. Filed under: Journals | Tags: |

Health Service Journal | By Steve Ford | 23 September 2009

Assessing how effectively NHS commissioners spend their funding receives greater importance in the latest government guidance on world class commissioning.

The revised version of the world class commissioning assurance handbook says competency number 11 – ensuring efficiency and effectiveness of spending – will be assessed as a core competency.

Competency six – to prioritise investment of all spending – is revised and now also requires primary care trusts to prioritise investment in different financial scenarios.

Reflecting the current financial situation, they are the most significant of the competency changes in the programme’s assurance handbook for year two, published by the Department of Health last week.

DH acting director general of commissioning and system management Gary Belfield said: “Commissioning has never been more important given the need for greater efficiency the NHS faces.”

The changes follow a comprehensive evaluation of world class commissioning assurance by the DH plus interviews and an online survey of more than 300 PCT and strategic health authority stakeholders. The handbook says overall world class commissioning assurance had been “judged a success” and was seen to be “rigorous and stretching”, with only “fine tuning” of the framework required.

Changes to the assurances include making the description of competencies, particularly sub-competencies, clearer about how the levels equate to different standards of performance.

Governance assessments are strengthened to differentiate more clearly between red, amber and green ratings; and better metrics have been introduced for some of the national outcomes, such as mental health and health inequalities.

NHS Birmingham East and North chief operating officer Andrew Donald welcomed the changes, which he described as “very subtle”.

He said: “They have listened to everyone and tweaked year two accordingly.”

He said the addition of competency 11 to the core list was “always going to be the case”.

“We are going to have to raise our competency in that area,” said Mr Donald.

At the end of world class commissioning assurance year two, July 2010, nationally calibrated results will be published by the DH to enable comparison across PCTs and improve the sharing of good practice.

Mr Donald said: “We need to link and share the learning,” and commissioners should “steal with pride” ideas from other trusts.

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The Private Sector and the NHS

Posted on September 4, 2009. Filed under: Arm's length providers, GP-led health centres, News stories | Tags: , , |

Pharmaceutical Field | 4 September 2009

The demands of world-class commissioning will mean increased collaboration between the NHS and the private sector. To stay ahead of the game, pharma companies need to be engaging with the private sector on a local level, argue Duncan Alexander and Mike Sobanja.cover


Despite many initiatives and government policies, the private sector has yet to play any major role within the NHS – especially outside England. Yet with escalating cost pressures and the very real prospect of a new government in 2010, there is little doubt that Strategic Health Authorities (SHA) and Primary Care Trusts (PCT) will begin to look more closely at opportunities for commercial partnership.

Indeed, while there is limited national consensus today, private sector initiatives continue to succeed at a local level. Given the current economic climate, pharma companies cannot afford to ignore these pockets of opportunity. It is only by understanding the very real differences in private sector/NHS collaboration at a local level that organisations will be able to respond effectively to the implications of strategic change, from world-class commissioning onwards.


Increasing competition

Since the Labour government came to power in 1997, there have been many grand statements and initiatives designed to increase performance and productivity across the NHS by introducing private sector competition.

Indeed, in January 2002, Alan Milburn, former Secretary of State for the NHS heralded the introduction of the private sector into the NHS, saying: “Our reforms are about redefining what we mean by the NHS. Changing it from a monolithic, centrally-run monopoly provider to a values-based system where different health care providers – in the public, private and voluntary sectors – provide comprehensive services to NHS patients.”

However, fears that such a strategy could lead to back door privatisation of the NHS certainly appear to be unfounded, with a number of initiatives failing to deliver real change or private sector involvement. And certainly across Wales, Scotland and Northern Ireland there is a clear move away from any private sector co-operation or collaboration.

But the changing economic environment will undoubtedly have a significant impact on NHS strategy over the next few years, especially in England, where the sheer volume of demand places huge cost pressures on PCTs and SHAs. Combined with an expected change of government in 2010, it is very likely that the NHS will be tasked with meeting clear targets for the use of private sector organisations to deliver services in a more competitive and cost effective manner.


Poised for change

Indeed, while the Virgin Group announced it had effectively put on hold its ambitious plans to take over and run GP surgeries in 2008, the company remains ‘very committed’ to entering the sector and will review the situation when the economy improves. 

Furthermore, the Department of Health remains bullish about the private sector’s role within the NHS, a spokesman recently asserting: “PCTs are expected to stimulate and shape the market, including a number of providers from voluntary, NHS, private, local government sectors and others.”

And private sector involvement with the NHS is occurring – albeit on a fragmented basis and at a local, not national level. Some 25% of contracts for the ‘Darzi centres’, for example, the GP-led health centres required to be introduced by all PCTs across the country, have been awarded to the private sector so far – although these include NHS hybrids that are simply relabelled organisations.

The Department for Health has also let a contract for the support of the development of practice-based commissioning, with five companies/consortia vying for contracts to give PBC a shot in the arm.


Defining opportunity

It is this highly fragmented response that is creating huge challenges for pharma companies today. And a fundamental issue to address is the speed with which PCTs respond to the demands of world-class commissioning, under which PCTs must become two separate organisations – the Commissioner and the Provider – by April 2010.

While the PCT’s commissioning side will not require many changes, it will be the establishment of the provider unit that will be of most interest, becoming as much as 80% of the PCT as it currently stands. The Department of Health has set a clear timetable for PCTs to undertake this huge change, with three stages – Arms Length Status (April 2009), Direct Provider Organisation (October 2009) and complete independence (the externalisation of the provider arm) by April 2010.

However, every SHA and PCT is progressing at its own pace – with early adopters and clear laggards. According to the latest figures from Cegedim Dendrite, 6% have achieved Arms Length Status by April 2009, 13% are significantly ahead of target and are already Direct Provider Organisations (DPO), with 66% on target to achieve DPO by October 2009.

Furthermore, different regions have adopted different strategies, with London splitting into five Commissioning Collaboratives (specialist commissioning groups) and six PCTs currently taking part in a national Community Foundation Trust Pilot Programme, under which they will be no longer be assessed by the SHA after a year’s operation and assuming the required level of governance and financial expertise.

The challenge for pharma companies is to assess and understand the progress of these individual NHS organisations in embracing world-class commissioning and understanding the implications for new business development.


Building for the future

While the private sector involvement in the NHS will undoubtedly remain small – at least until the next election, pharma companies cannot afford to ignore the opportunity. Indeed, the continued perception that both the NHS and, by association, pharma companies will be unaffected by the current economy is, quite frankly, ridiculous. With the escalating levels of public debt any government will be forced to claw back funding over the next few years. Should a Conservative government take over in 2010, the NHS is likely to experience a massive policy shift that will force SHAs and PCTs to work far more closely with the private sector.

Pharma companies cannot operate in an information vacuum. This private sector/NHS co-operation will continue to be introduced on a piecemeal, local basis. In this climate it is essential to maximise opportunities, operate efficiently and, furthermore, build relationships with key individuals who will be increasingly involved in defining the NHS/private sector model.

Without up to date information on changes in attitude and adoption at a highly granular – preferably PCT – level, pharma companies simply will not be able to respond effectively to any new commercial opportunity.



Duncan Alexander is OneKey Director at Cegedim Dendrite, where he is responsible for managing the existing client base and the co-ordination of all UK commercial activities. Cegedim Dendrite has over 35 years experience in providing value added information and CRM solutions to the pharmaceutical industry and healthcare professionals.

Mike Sobanja is Chief Executive of the NHS Alliance – the independent body that represents NHS primary care. Values-based, the NHS Alliance is the only organisation that brings together PCTs with GP practices, clinicians with managers and board members, and NHS primary care with its patients. The NHS Alliance membership and its national executive are fully multi-professional.

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Mark Britnell quits NHS for private sector

Posted on June 11, 2009. Filed under: Journals | Tags: , |

Health Service Journal | BY RICHARD VIZE | 11 June 2009

HSJ understands Mark Britnell, NHS director general for commissioning and system management, is to join consultancy KPMG. 1202875_57385_306

He is on gardening leave from the Department of Health.

He is expected to play a leading role in KPMG’s European health practice.

Mr Britnell has been the leading reformer in the NHS management team. He launched the world class commissioning drive, and has always been a staunch advocate of private sector involvement in the NHS.

He recently established the co-operation and competition panel to ensure fair access to the healthcare market.

Academic Chris Ham said the panel’s draft interim guidance read as if it had been written “by a neo-liberal economist on speed”.

Mr Britnell also established the framework for securing external support for commissioners (FESC) to encourage private sector involvement in world class commissioning.

He was unavailable for comment.

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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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