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
European Working Time Directive - junior doctors
From August 2009 all junior doctors will have to comply with the maximum of an average 48 hour working week (the current maximum is 56 hours per week). To support providers in achieving this reduction in hours some £310 million is being made available in 2009-10 (£260 incorporated in tariff uplift and £50 million allocated to SHAs). Although primarily an issue for providers, achieving compliance may, in some cases, have significant workforce implications or need support for service rationalisation or reconfiguration. The 2009-10 operating framework sets out that PCTs should play a role in ensuring that their providers have plans in place to achieve compliance, and that these should be risk assessed, as part of understanding the strategic workforce implications of their commissioning strategies. Commissioners will also need to lead any discussions on significant service changes where these are agreed or required as part of achieving compliance.
Advice and support on WTD compliance is available from the Workforce Projects Team at Skills for Health, via their website at http://www.healthcareworkforce.nhs.uk/workingtimedirective.html.
The NHS Employers website provides additional information on the background to the Directive and sources of support, see http://www.nhsemployers.org/workforce/workforce-4158.cfm.
Operating framework 2009/10
The DH published the Operating Framework for 2009/10 last week, alongside the allocations for PCTs for the next two years and the new standard contracts for mental health & learning disability services, community services and ambulance services. The PCT Network has produced a simple easy reference list of 75 requirements for action for PCTs which are contained with the Operating Framework. For more information, please contact david.stout@nhsconfed.org.
Assurance Framework - Update
As you know, after a long gestation process the World Class Commissioning assurance process is finally underway with the first PCTs undertaking the panel reviews The DH will be undertaking a formal evaluation of the process once all PCTs have completed their assessments by the end of the financial year. This evaluation will inform any changes to the process for future years.
The PCT Network will be asked to feed in views from PCTs so I would be keen to get feedback from Chairs, Chief Executives and PEC chairs on how they felt the process has gone. PCT Network would also be interested in feedback from those Chief Executives who have been part of the assessment panels as they may have a different perspective.
Early feedback from the first PCTs being assessed will be particularly useful for any immediate messages for the DH.
All feedback will be treated confidentially. Please email David Stout or call on 020 7074 3223 with any comments you have.
Practice based commissioning framework
The Department of Health has established a PBC Development Framework to provide SHAs, PCTs and Practice-based Commissioners (PBCs) with a one-stop shop for training and development to help them get to grips with PBC. The framework offers techniques and tools from quality assured organisations that will help strengthen local support arrangements and skills for PBC, including organisational and leadership development, information analysis, business cases and patient and public engagement. For further information and supporting documents visit the DH website.
Practice-based commissioning: delivering the vision
The vision for primary and community care set out in the NHS Next Stage Review (NSR) presents practice based commissioning (PbC) as a critical mechanism for transforming service quality and health outcomes for local communities. However, along with other commentators, NSR also acknowledges that (with some exceptions) PbC is not yet achieving its full potential.
The Department of Health (DH) is now committed to working with the NHS and with the professions to redefine and reinvigorate
PbC and to place it at the heart of world class commissioning. The PCT Network has been working closely with the DH to ensure members' views and experiences help to shape the development of PbC policy.
The discussion paper on Practice Based Commissioning - Delivering the vision has derived from a seminar convened by the Network earlier this year, and forms part of our ongoing contribution to the debate. We know that the DH is working advice around devolving budgets and managing contestability and perceived conflicts of interest for PbCs. While acknowledging that this work is essential, our paper aims to refocus discussion on the outcomes PbC is intended to deliver, and the principles that need to underpin relationships between practices and PCTs.
The paper is designed to stimulate discussion and is not intended to be our final position statement on the subject. We would welcome your views on the vision and principles we have outlined, so that we can continue to feed these into policy decisions. Please feed your views to jo.webber@nhsconfed.org.
World Class Commissioning Timetables
The DH has now set out the timetable and process for publication of the world class commissioning ratings. Following national calibration at the end of January, PCTs will be sent their individual reports and ratings from their SHAs at the beginning of February. PCTs will be expected to publish their results by the end of February at the latest. SHAs will not collate reports or ratings until March to allow each PCT to publish its own results first. PCTs will be provided with a briefing pack to support their local communication work.
Thank you for your feedback on your experiences of the process so far. Please feed any further views through to david.stout@nhsconfed.org. The DH will undertake a formal evaluation of the process in February.
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.
NHS Employers and the GPC announce changes to the gms contract, 2009/10
Each SHA is holding a contract implementation support workshop in October/November for their commissioners and providers. The events are to introduce the emerging contractual requirements and processes in advance of the publication of the NHS Operating Framework and the contract guidance. All PCT and joint commissioners, and all providers of NHS funded Mental Health, Learning Disability and Community services (including NHS Trusts, NHS Foundation Trusts, independent sector and third sector providers) are invited to attend these workshops. View the agenda and venues. To register for these workshops please go to the PCC website.
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.
