Commissioning challenges:relationships between publichealth specialists and clinical commissioners Dr Chris Packham RCGP National Commissioning Champion GP and DPH
What commissioning?• CCG authorisation • Equity and Excellence – Clinical focus – Redesign clinical – Patient engagement pathways – Credible plan – Partnership with – Governance hospital specialists – Collaborative – Responsibility for commissioning financial decisions – Leadership – LTC management – Strip out….activities that do not benefit health
QIPP and the DH expectations• The NHS QIPP challenge: ‘David Nicholson’s 20 billion’• improving quality: more effective services, increased productivity and efficiency• Elements of cost reduction to fund – Quality – Innovation – Prevention• The scale of challenge requires transformation• NHS inflation around 4-5% (1-2% demographics 3% technology costs)
some commissioning tasks• Do Health Needs Assessments* (and EIA*s and HEA*s and HIAs*)• Agree the facts with the public, politicians and stakeholders*• Design and model your plans*• Decide what to prioritise*• Communicate• Procure• Monitor*• Evaluate* * Require specific public health science skills
Some more commissioning tasks• How do we get a whole system approach – Social care spending to save hospital bed blocking – Housing spend to save mental illness admissions• Balancing what is best (NICE guidance) with what is affordable• Rationing• Using evidence – Heart failure (cost saving) – Total Parenteral Nutrition complications 44% to 9% – For every 1% fall in smoking rates in persons with established vascular disease reduces subsequent NHS utilisation by 2% over a 3 year time frame
QIPP dilemmas: local example – Health checks• 40-74 CVD healthchecks.• 78,000 required to find 8,000 with a CVD risk >20%• Locally adopted a highly targeted approach• Found 80% of the high risk group by seeing 13,000• Estimate see 21,000 to get 93%• SHA demand – see 78,000!
ExampleGeo-demographic profiling:Mapping smokingcessation activity by area
Public health and clinical commissioning• (good) GPs bring • (good) Public Health brings – Clinical reality – Technical analysis – Safe, efficient re- – Population perspective design – Material to allow GPs – Patient-friendly plans to make decisions – Problem-solving with – Rational basis for hospitals unpopular decisions – ‘credible’ rationing – Wider determinants actions – Social care link