ABI Specialist Service Commissioning The Key Role of the Primary Care Trust

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ABI Specialist Service CommissioningThe Key Role
of the Primary Care Trust

• Maggie Campbell
• Sheffield Primary Care Trust

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The story so far..

• Approaches to specialised commissioning
• A view from a Local Authority
• The example of a specific approach via the
  development of a strategy for service development
• The highs and lows of trying to work in
  partnership (PCT/LA)
• The complexities of developing fair and adequate
  costing mechanisms for some aspects of the care
  pathway

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So, what do we know?

• Its a work in progress
• There isnt a fully developed template to be
  lifted and applied
• Its complex
• In terms of the pathology itself (ABI)
• In terms of the needs that emerge

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Thinking about (service) needs

• Some are pathology specific
• Some are pathology group (LTNCs) specific
• Some are held in common with others who have long
  term conditions
• Some are held in common with those of us lucky
  enough not to face specific challenges

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Thinking about (what) services (need to be)

• Multidisciplinary (and specialisms vary across
  disciplines)
• Multiagency (where the traditional presence of
  disciplines and their roles may vary)
• Working within an Interdisciplinary Framework
  (yet to be established in many places yet to be
  understood in almost as many)
• Person-centred (not yet the common experience
  there is sometimes something like it, some of the
  time)

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Who is responsible for making all of this work?

• According to the DH (May 2006), PCTs have 3 main
  functions
• To engage with local populations to improve
  health well being
• To commission a comprehensive equitable range
  of high quality, responsive and efficient
  services, within allocated resources
• To directly provide high quality, responsive
  efficient services where this gives best value
  (best for patients, best for taxpayers)

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PCTs should (among other things)

• Lead their local health system
• Develop and delivery their functions through
  effective partnerships, particularly with
  Practice-based Commissioners and Local
  Authorities and with a full range of providers
• Hold providers to account through commissioning
  contracting
• Be accountable to the local population and the
  Strategic Health Authority

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How are they to achieve this?

• PCTs are responsible for ensuring comprehensive
  equitable commissioning that results in high
  quality, responsive and efficient services.

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PCT Commissioning Mechanisms

• Partnerships with
• LAs
• Other PCTs (specialised services)
• or via national arrangements for very
  specialised services
• By empowering, supporting co-ordinating a
  comprehensive system of practice-based
  commissioning (which excludes specialised
  services)

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Partnerships

• Local Area Agreements (LA/PCT/FTs)
• Statutory partnership for health and well-being
• Common assessment framework
• Single budgets
• Joint targets
• Strong patient/user voice
• More visible leadership
• Joint appointments, pooled budgets, joint
  commissioning
• Joined up public health and social care priorities

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Partnerships

• Specialised commissioning
• Historically based on National Definition Sets
• (7) Complex specialised rehabilitation services
  for brain injury and complex disability
• (8) Specialised neurosciences services (including
  neurorehabilitation activity attributable to
  consultants in neurorehabilitation (IP OP) but
  excluding head injuries with a hospital stay of
  lt48hrs)
• complex (specialised) rehabilitation service
• High cost, low volume (est. 10-20 /100 000),
  regional
• specialist
• District level

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• All patients admitted to neurorehabilitation
  units and brain injury units should be included
  but
• further work is needed to identify patients in
  this category
• In practice this seems to work relatively well
  for those admitted to neurosciences until the
  point of transition but has been less effective
  for neurorehabilitation as a whole.

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Review of commissioning arrangements for
specialised services

• Reported May 2006 (Sir David Carter)
• 32 recommendations
• Standardise arrangements and reduce the numbers
  of levels of commissioning
• A national specialised commissioning group (SSCG)
• A SSCG for each health authority area
• Compulsory representation of each PCT with proper
  delegated authority

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• Rec 20
• PCTs should act as the focal point in ensuring
  good fit between commissioning plans and priority
  decisions of GP Practices and those of the SCG so
  as to maintain and strengthen integrated care
  pathways.

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• Rec 31
• The profile of specialised services and their
  commissioning arrangements needs to be raised
  both within and outside the NHS and should be
  given a higher profile in the career options for
  managers and clinicians. SHAs should ensure that
  career development and training programmes
  recognise the necessary expertise required for
  commissioning specialised services.

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• Definition sets to be reviewed and a programme
  for regular review and updating described
• Neurohabilitation (and neurosurgery) to be
  included

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Practice based commissioning

• GP practices (or groups of practices) taking on
  delegated budgets from their PCT to become more
  involved in commissioning decisions for their
  patients
• Not compulsory for practices but there are
  expectations on PCTs to create the environment to
  make it happen
• The scope of the budget is negotiable locally

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• Practices become responsible for the utilisation
  of services within the agreed scope/budget can
  redesign, can re-invest (at least 70 of) savings
  back into patient care by agreement and with
  the approval of the PCT
• Practices (or groups of) can ask the PCT to
  commission particular services on their behalf
• PCT remains responsible for financial balance and
  for negotiating contracts or SLAs with secondary
  providers

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• Practices can commission services from social
  care
• It is envisaged that this will be underpinned by
  joint health and social care needs assessments
• Joint Strategic Needs Assessments are being
  proposed as part of the primary mechanism for a
  Commissioning Framework for Health and Well-being

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• PCTs have a key role in the current and future
  commissioning of ABI (and other specialist)
  services
• There is a pressing challenge to ensure that the
  mechanisms for assessment of need and for
  ensuring joined up provision are inclusive of the
  complex requirements of those with ABI
• All those with an interest is achieving positive
  developments in this area are duty bound to
  constructively inform and educate PCT colleagues
  to raise awareness of need and develop innovative
  solutions to ensure the delivery of meaningful
  service provision

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Consultation

• Commissioning framework for health and
  well-being
• www.commissioning.csip.org.uk