This work area is a key priority for the Network, with a major focus on the support and development programme for PCTs around world class commissioning competencies. The board members leading this work area are Lise Llewelyn, Chief Executive of Berkshire East PCT, Maureen Donnelly, Chair of Cambridgeshire PCT, Yasmin Chaudhry, Chief Executive of Durham PCT and Alan Stephenson, Chair of Ashton, Leigh & Wigan PCT.

Latest Department of Health world class commissioning updates:

• Draft competency measures
• Assurance system update
• Draft consultation on strategic plans
• World class commissioning update

Development of World Class Commissioning

The PCT Network has been working with Mark Britnell, Director General for Commissioning and System Management at the Department of Health (DH) and his team, together with the NHS Institute for Improvement and Innovation to support the development of world class commissioning.

Developing a world class commissioning function will be crucial if health and care services are to achieve the best possible outcomes for patients and users, improve health and reduce health inequalities, while ensuring that resources are invested effectively and efficiently.

Building on the Fitness for Purpose exercise, and the joint DH and Prime Minister Delivery Unit review of PCT commissioning capabilities, the DH plans to develop a programme to support the development of world class commissioning. This has three main aims:

• To articulate the vision for world class commissioning over the next five years, clearly setting out what world class commissioning is and what PCTs need to do to achieve it
• To put in place an earned autonomy system for effective commissioning in order to hold people to account and reward development
• To put in place a support and development programme that PCTs can access to improve their commissioning capability.

The vision and the competency framework were launched by the DH on 3 December with input from the PCT Network. The Network also supported the DH on the Accelerated Strategic Events in November and December where over 60 percent of the participants in the three events were from PCTs.

Latest update from the DH on World Class Commissioning

A letter from Gary Belfield director of commissioning at the DH, gives an update on progress on world class commissioning, including the latest on the assurance framework, the board development framework and practice-based commissioning. Read the letter here.

Draft NHS standard contracts for community services and mental health services

The DH working group is now in a position to share the latest draft of the NHS Standard Contract for Community Services, and the service specifications. This version has been tested by a range of PCTs and providers. Details of test sites can be found on the Department of Health website. A series of regional workshops will be run by NHS Primary Care Contracting during October and November - for more details see the PCC website.

The draft Mental Health contract has also been released for consultation by the DH. Please comment on the draft to ensure that DH understands your particular issues. It is important that stakeholders assess the extent to which these have been effectively translated, and take account of the specific features of mental health commissioning and provision.

David Stout's letter to Bob Rickets, sets out the PCT Network's response to the draft mental health contract following consultation with our members. Comments include general support for a standard contract for mental health services but disappointment that the draft contract has not included many mental health specific priorities and may lack real meaning and resonance for mental health providers and commissioners. There is also concern that the approach does not take sufficient account of integrated health and social care arrangements.

Assurance Framework

The DH invited the PCT Network to participate in the selection process for the consultancy support to develop the assurance process for world class commissioning. Yasmin Chaudhry sat on the selection panel at the end of February. A consortium led by McKinsey comprising Kaiser Permanante, Humana, Dr Foster Intelligence, Mental Health Strategies and Ernst & Young were been selected to work with all PCTs and SHAs over the next year.

The compliance and assurance system - based on the experience of the PCT pilots in the North West - will be further developed by Summer 2008. It will then be consistently implemented across the NHS by Spring 2009.

The DH has also invited the PCT Network to sit on the board overseeing the implementation of the assurance system. The consortium headed by McKinsey plans to deliver the framework in 4 phases:

• Phase 1 (by end April 2008) - finalised content of the assurance system, guidance to support the process and finalised incentives and consequences for different levels of PCT performance.
• Phase 2 (by end May 2008) - an electronically available toolkit for PCTs and SHAs to implement the assurance system
• Phase 3 (by end September 2008) - development of SHAs capacity and capability to implement the assurance system in all their PCTs
• Phase 4 (by end March 2009) - completion of first iteration of assurance process with self assessment in August/September and panel reviews in November/December.
  
  

Support & Development Programme

The initial proposals for a national programme for support and development for PCTs set out in the 'Good to Great' document were not supported by the DH's Commissioning & System Management Executive which identified the area of governance as being the sole area where a single national development programme was required. At the time of writing the scope of this area had not been defined.

The PCT Network, working with the Institute of Improvement and Innovation and other partners, has developed proposals for an accelerated development programme for PCTs to underpin delivery of the World Class Commissioning agenda.

NHS Institute World Class Commissioning support for Boards in achieving world class commissioning is now available. Two key products are:

NHS Board Development Tool: This well tool challenges Boards to consider if they meet core functions such as setting strategy, building stakeholder relationships, managing performance issues, and operating corporately. It builds a platform for improving Board effectiveness.

Executive Coaching: Research demonstrates this is usually one of the most effective supportive mechanisms an NHS leader can access. PCT Chairs, Chief Executives and Executive Directors can access highly experienced Executive Coaches who can help improve competencies across a range of areas.

Details on both these programmes are available from: http://www.institute.nhs.uk/wcc

The NHS Institute is also developing a development programme for Non Executive Directors, to provide a universally high standard of Board performance; a programme enhancing Board members' political understanding and external focus to better position their organisations; and a Team Coaching programme to improve the leadership effectiveness of whole Boards.

A group of PCTs have also got together to commission a development programme for PCTs - Look Out Not Up - to prepare for the challenges of world class commissioning.

New contract for 2008/09

The PCT Network has been involved in the DH development of the new contracts for 2008/09.

The standard contract for acute services was issued by the DH with the Operating Framework in December 2007. The PCT Network co-ordinated PCT input into the development of this contract with hands-on commissioning expertise drawn from the NHS Employers/HFMA Finance Reference Group and the Network of PCTs which commission from Foundation Trusts.

Many of the principles and basic elements of this contract will be appropriate for the standard contracts for Ambulance, Community and Mental Health Services, and work is now in place to identify the additional specific requirements of a robust and comprehensive approach to contracting for each of these services. This work will benefit from additional DH resources and will involve learning from the work many commissioners and providers have undertaken to develop their own contractual arrangements. The DH will continue the development work until March to ensure that the contracts are as robust as possible. A number of local health communities will test and refine the interim contracts and to introduce them as early adopters. This approach will enable final versions of the contracts to be introduced across the NHS from April 2009.

Payment by Results

The PCT Network is represented on the National Payment by Results (PbR) Programme Board by John McIvor, Chief Executive of Lincolnshire PCT, and David Stout. The Network has also had input into the PbR Technical Group. The Department of Health has recently issued a response to the consultation on the future of PbR

Priority setting publications

Our work on priority setting has been published in collaboration with the NHS Institute and the Economic and Social Research Council (ESRC). This work is intended to outline a framework for priority setting and provide a useful resource for members, with information on contracting, legal issues and judicial review.

Priority setting: an overview provides an overview of the complexity of allocating resources in an increasingly demanding and politically sensitive environment.

Priority setting: managing new treatments sets out some of the key considerations for developing priority setting in relation to new treatments, with a useful list of action points.

Priority setting: managing individual funding requests explores this area of decision making and provides some good practice points in relation to managing IFRs and dealing with clinicians and patients.

Priority setting: legal considerations looks at the judicial review proceedings, the duties of the Secretary of State for Health and PCTs; the role of NICE, prescribing rights in primary care, European Union law and human rights law, and also provides some tips on working with lawyers.

Priority setting: strategic planning. This report sets out some well recognised considerations for the planning cycle and presents some tools which may be useful for PCTs to adopt and adapt.