Jobbing commissioning working across a range in Specialist services, background in community health council, user involvement work and primary care mental health commissioning. Currently involved in commissioning healthcare in HMP Manchester, Here in personal capacity – want to overview commissioning, take you through two areas of work that sit between the worlds of GPs and
So why is commissioning like shopping??? Its about using a market place to get the best you can for your patients!
Its important that we keep thinking about were we get our services from and whether they are meeting the needs of our communities……..so if commissioning is like shoppping…..
Also know as sophisticated shopping - why do we need commissioning Have we been shopping at the same shops and not buying what was need World class commissioning has been one of the key vehicle for refreshing our skills and as we move on to the next phase GP commisisoning worth us looking at understanding it well. Our communities are changing, living longer, we have new challenges alcohol drugs, technology…need to keep developing
Air conditionning, back doors cos the kids are getting bigger, capuccino holder? Consider the other pressures on your budget So if you were commissioning that care …. You would need to ,,,,, So how does it look against the commissioning cycle……….
Go back to thinking about shopping You assess what you need: bit like shopping what do I need for the grocery this month? Who am I feeding, what are their likes dislikes, dietary needs. What do I already have in the cupboard what would be healthy, nutritious What menus should I have Where should I shop – market, kwik save or waitrose. Can I make it last – do I get vfm Did they eat it, like it should I go back again? Is the food safe The intention of behind quality commissioning is that commissioners will take a long term strategic approach to commissioning. For example, in greater manchester we collectively work together to commissiong bariatric surgery and set agreed criteria for access . For example Heywood Middleton and Rochdale PCT have joined forces with Sport England and the Big Lottery Fund to regenerate sports facilities in the community, supporting the long-term shift from diagnosis and treatment to prevention and the promotion of well-being. The PCT has also employed dedicated community workers to develop services that are of interest to the local population to encourage healthy lifestyles and improve public health.
Prisoners 13 times more likely to be in social care as a child 10 times more likely to be truant from school 20 times more likely to have attended a special school 22 times more likely to be excluded from school 13 times more likely to be unemployed 6 times more likely to be a young parent
Know that people in prison tend to lead high risk taking lives and have 3-4x the dental issues experienced in the community
Dental service linked to our local dental practitioners Anti-coagulant service linked to local acute service contract developed by hub COMMISSIONERS AND LINKED TO LOCAL CONTRACTS Drug service linked to our local community pathway and providers to build on links and pathways homes Smoking cessation additional input from our HP unit…..especially as smokng now banned in healthcare –reduced the LOS Social care supporting the development of carers helping older prisoners NHS Manchester BENCHAMRKED costs with other prisons…….. To check vfm…….. MOST DEVELOPMENTS LINK BACK INTO LOCAL SKILLS AND LOCAL RESOURCES - PRISON COMMISSINONING TO GO TO THE NATIONAL
A leading stomach surgeon has experienced a '400 per cent' increase in inquiries about gastric bands since TV's Fern Britton revealed she lost five stone after the procedure, it was revealed today. Small service, picked up after a number of other key services had been in place – gap in local pathway no specialist service for people before they need surgery – no where to send them to when they havent.
Currnetly costs 10k an op only have capacity in current contract tor approximately 30 manchester residents – can buy it in Belgium for 3.k We were spending over a million beforea Set up a panel to ensure critieria met Raised criteria in line with other local pcts – above Nice Actual service well monitored and deliered by NWsct Provision doesn’t meet want – high levels of patient demand Readjusting our financial budgets and kept analysing our throughput to match funding Due to the raised criteria have reserved funds to put in place the weight managemet service we need. Issue IS THE NOISE outside the contract procedure that needs managing around the conract e.G enquiries gaps in
What I want to talk about• Do a quick overview of the science of commissioning• Discuss two areas of work that sit between our local communities and specialist services• Discuss some challenges for keeping strong local links for services a step away from GPs.
Did you? • Go back to the same garage? • Buy the same model as last year? • Pay the manufacturers asking price? • Are you pleased with the car in terms of comfort, speed and reliability • Do you know if it was value for money?
Commissioning ? Buying services Needs to be fresh Quality Meet need vfm
Commissioning the car?• Work out what you needed and how much it would cost to run.• Buy ethically• Check carefully what other demands would be placed on your budget• Shop around a few garages first to work out who had the best deals for the car you wanted• Negotiate a good price including warranty and servicingDid you shop/commission what you needed…..
ChallengesSecurity comes firstStaffing require CTC – takes 3 monthsRequired to provide equitable services to communityLimited escorts outNeed to get services in and integrate back homeService delivery long due to security inputsHigh dna rates…high waiting lists (Links)
What we have• Strong in house team of nursing, mh and drugs staff• Inpatient unit – 28 beds• Primary care centre with practitioners (dental, pharmacy, podiatry)
Some examples of what we have bought and developed• Telemedicine service offering A&E and clinics• New dental service• New anti coagulant service• New integrated drug treatment service• Stronger links with social care• Increased smoking cessation• Review of mental health services to link with local pathways• Chronic disease registers and support for older prisoners
Developments link into our local relationships and provisions Will we still be able to link as effectively into the good will of our local services Post the transfer of our community services Will the working relationships between public health/prison/gp be strong enough?
Can you take on Bariatrics?• Budget based on last years spend• Obesity crisis• Fern factor• Contract established but lots of last years people still waiting!• Pathway gaps• NICE levels
Scope out problem• Find out what bariatric surgery is• Find out how many people need it• Find out if we can afford it• Find out what processes are in place to monitor and deliver it• Find out if we have users views
Local Bariatric Challenges• Handling expectation and Need• Fit wit local services and pathways• Current system gives GPs barrier and not direct NO• Still need to commission local dietetics service etc. ?