Judith Smith and Chris Ham: Commissioning integrated care - what role for clinical commissioning groups?


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Dr Judith Smith, Head of Policy at the Nuffield Trust, and Professor Chris Ham, Chief Executive of The King’s Fund, share the findings of their recent research into how NHS commissioners have been commissioning better integrated services and care for people in local areas.

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Judith Smith and Chris Ham: Commissioning integrated care - what role for clinical commissioning groups?

  1. 1. Commissioning integrated care: whatrole for clinical commissioninggroups?Dr Judith SmithHead of Policy, the Nuffield TrustProfessor Chris HamChief Executive, The King’s Fund20 October 2011 © Nuffield Trust
  2. 2. Agenda • The research project • Case studies of commissioning integrated care • Emerging themes • Policy implications © Nuffield Trust
  3. 3. The research projectProject aim• To understand how NHS commissioners were using their leverage to develop more integrated care• To examine the extent to which such attempts were focused on efficiency, as well as service quality• To consider what this means for commissioning in economic hard times, and in the new reform context © Nuffield Trust
  4. 4. Case studies of commissioning integrated care • Birmingham North and East PCT – commissioning integrated care for people nearing the end of life • Milton Keynes PCT – seeking to contract an ‘accountable care organisation’ for a whole programme of care • Tower Hamlets PCT – commissioning outcome-based diabetes care from networks of providers • Smethwick Pathfinder – a group of GP practices holding a capitated budget for managing the care of people with long-term conditions © Nuffield Trust
  5. 5. • Cumbria PCT and practice-based commissioning – commissioning integrated diabetes care across a county, using a new specialist care organisation• Knowsley PCT – contracting with a lead specialist provider to deliver the full range of cardiovascular care for a population with major health inequalities• Somerset PCT – commissioning an integrated COPD service from a partnership of BUPA and a company formed of local GPs• West Kent PCT – commissioning a social enterprise to deliver integrated out-of-hours primary care and emergency primary care, based in the hospital A&E © Nuffield Trust
  6. 6. Emerging themes – the cycle of commissioning • Needs assessment and service specification – took up considerable time and resource, helped with engagement, but hard to move to implementation • Contracts – a range of mechanisms used, including PMS, GMS and adaptations of PbR and acute contracts. Seems there is more potential to use existing mechanisms • Tendering and procurement – costs of this were prohibitively expensive in some cases, yet others were able to contract for new forms of care across organisations • Outcomes and incentives – the value to be had from linking payment to expected outcomes, and doing this in a phased manner © Nuffield Trust
  7. 7. Emerging themes – facilitators of new approaches • Managerial leadership – senior support, drive, and risk- taking • Clinical leadership – as commissioners and providers – clinicians typically the drivers of new models of care • Data and IT – critical to contracting, tracking outcomes, developing sophisticated payment approaches • Provider engagement – it is costly for providers to be involved, and a risk for them, and they will need support • Time and persistence – takes a lot of time and resource to plan and implement major change © Nuffield Trust
  8. 8. Policy implications – NHSCB and Monitor • Central support for commissioning of integrated care is vital • The role of Monitor will need to be crafted in a way that promotes both competition and integration • There is a need for further and more extended experimentation with tariff and incentives for integrated care • A range of approaches to contracting and procurement will be needed © Nuffield Trust
  9. 9. Policy implications – clinical commissioning groups • Developing new forms of integrated care is what is most likely to excite and engage clinical commissioners • Some GP commissioners will want to be able to ‘make’ as well as ‘buy’, and policy on conflicts of interest will need to address this • There is a need to think again about how the commissioner-provider split might operate in future, perhaps testing out new integrated provider-funder organisations • In whatever approach, aligning incentives across primary and secondary care, and also social care, will be vital © Nuffield Trust
  10. 10. To conclude ‘commissioners who want to incentivise providers to develop better integrated services should focus on developing outcome measures and incentives that encourage them to bring about these new forms of care. This is much more likely to be successful than trying to over- specify the details of the structures the commissioners feel the providers should put in place.’ Ham, Smith and Eastmure, 2011, research summary report p10 © Nuffield Trust
  11. 11. Download the research report & summarywww.nuffieldtrust.org.uk/publications/commissioning-integrated-care © Nuffield Trust