NHS Reform: why effective contracting within primary care matters

1
NHS Reform why effective contracting within
primary care matters

• Oliver Phillips
• Head of Commissioning Reform
• 18th October 2007

2
Outline

• What do we mean by contracting within primary
  care?
• The health reform landscape
• Why effective procurement matters
• Emerging issues and implications
• What makes effective procurement?
• The current situation
• Where next?

3
What do we mean by contracting within primary
care?
Community Based Services
GPs with a Special Interest
Essential GP Services
Outreach
Acute Care
Community Hospitals
Enhanced Services
Social Care
4
Not just about procurement

• Needs analysis
• Demand management
• Developing pathways
• Monitoring management and review

5
The Health Reform Landscape
Our Health, Our Care, Our Say
Practice Based Commissioning
Value for money
Plurality and Choice
18 weeks
Commissioning Competencies World Class
Commissioning
6
Aims

• Provide more convenient care out of hospital,
  closer to patients homes
• Clinically- and patient-led commissioning
  decisions
• Greater access and responsiveness
• Demonstration of benefits and VFM
• A greater range of providers and more choice

7
Implications

• Wider range of services provided outside NHS
  acute contract and GMS
• Expanded delivery role for primary care
  clinicians
• Market development role
• Commissioner-driven local services

8
Issues

• Conflicts of interest commissioner/provider
  business cases
• Lack of clarity in contracting guidance
• Limited range of providers available
• Evidence of clinical effectiveness
• Assuring provider quality
• Producing effective service specifications and
  monitoring performance
• The role of the PCT provider arm
• Lack of procurement expertise
• How to encourage innovation

9
What makes effective contracting?

• Transparent procurement process that delivers
  best value
• Clear service specification that meets patient
  need
• Ability to monitor, evaluate and manage/
  challenge provider performance

10
Existing guidance

• Provision to own population under an existing
  contract
• Any Willing Provider
• Tender route monopoly provision

11
What is the local picture?

• Variable experience and skills
• Many PBC schemes small and offered under LES or
  as pilot arrangements
• Governance frameworks that need testing in
  practice
• Need to develop expertise within each PCT
• Need to apply rigorous monitoring and performance
  management to all providers
• Learning from experience

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What next?

• Explore some of the issues and dilemmas
• Learn from case studies and expertise
• Network with colleagues in SEC
• Agree any additional collective work
• Work through existing networks
• Test governance frameworks and share experiences

13
Contact us

• Oliver Phillips, Head of Commissioning Reform
• Karen Clinton, Programme Manager Commissioning
  Competencies
• Julie Flower, Programme Manager Primary Care
  Contracting and PBC
• firstname.surname_at_southeastcoast.nhs.uk