Outcomes Based Commissioning in Richmond

1. Joint Commissioning Collaborative
Making outcomes that matter
Introducing outcomes based commissioning in
Richmond
Jacqui Harvey, Accountable Officer, Richmond CCG
Cathy Kerr, Director of Adult & Community Services,
Richmond Council
4 December 204

2. Joint Commissioning Collaborative
Changing how we commission community services
• Fragmentation of services and how they are accessed
undermines patient experience.
• Staff feel the way the service is commissioned and managed
gets in the way
• Many GPs experience the current service it in a way which is
almost random. GP referral patterns, usage, experience and
satisfaction all vary widely
• The current commissioning contract does not enable the CCG to
fully meet its goals to improve patient health and service
outcomes.
The case for change :

3. Joint Commissioning Collaborative
Community health services

4. Joint Commissioning Collaborative
Traditional commissioning …
• Commissioning based on activity levels as proxy
for outcomes
… or finance as proxy for activity
• Attempts to control activity and processes regardless of patient
need
• Creation of perverse incentives
• Preserves fragmentation
• Tendency to over-specify or mis-specify
• Not aligned with what patients want

5. Joint Commissioning Collaborative
Outcomes based commissioning
• Relatively new approach to commissioning health and
social care services in the UK
• Rewards both value for money and delivery of better
outcomes
• Requires a change in the “currency” underpinning
contracts
• Moving away from process and activity measures
• Greater use of indicators of patient outcomes

6. Joint Commissioning Collaborative
An ‘outcome’ refers to the impacts or
end results of services on a person’s
life
What is an outcome?
Outcome-focused services aim to achieve the aspirations,
goals and priorities of service users or patients.

7. Joint Commissioning Collaborative
What are the benefits of OBC?
Increased focus on
whole-person care
1
Enabling
collaboration and
integration
2
Realising efficiencies
in the system
• OBC aligns incentives across the health
and social care to deliver the outcomes that
matter to patients and the public.
• Rewards outcomes and not just activity -
OBC puts resources in the right place in the
system to maximise value
• OBC means providers are supported, and
incentivised, to work together to deliver
whole-person care
• Improved patient and service user
experience through reduced fragmentation
of services and improved models of care
• OBC is focused on improving the quality of
whole-person care, but evidence suggests
that it can also result in efficiencies of 10-
15%
• Promotes investment in prevention and
more effective and efficient working
practices
• Can reduce duplication across the system
• Opportunities to deliver care in lower cost
settings
3

8. Joint Commissioning Collaborative
Developing outcomes for Richmond
– the story so far
• Community research and engagement and outcomes
development
• Mapping current services and analysis of “as is”
• Starting to look at what a new model for community
services would look like

9. Joint Commissioning Collaborative
Next steps for outcomes based
commissioning in Richmond
Jacqui Harvey, Accountable Officer, Richmond
CCG
Cathy Kerr, Director of Adult & Community
Services, Richmond Council
4 December 204

10. Joint Commissioning Collaborative
Two stage process to achieve an OBC contract for community services and
out of hospital care across health and social care
• Stage one: To enhance the 2015/16 contracts and move providers towards
an OBC approach.
• Stage two: To let a more complete OBC contract for community services
and out of hospital care from April 2016.
• These recommendations have been agreed by the OBC Programme
Board and Richmond CCG Governing Body.
Two steps to 2016/17

11. Joint Commissioning Collaborative
Moving towards OBC and enhancing 2015/16 contract
Health
Prevent
-ion
Primary
Care
Mental
Health
Acute
care
Social
Care
Current HRCH
community
services
including (not
exhaustive):
• District
nursing
• RRRT
• Diagnostics
• Rehabilitation
• MSK
• Diabetes
• Podiatry
• Paediatric
services
Community and out of hospital services Service providers
Community
Services
• HRCH
• Your Healthcare
Acute Care
• Kingston Hospital
• West Middlesex University
Hospital
• Chelsea and Westminster
Hospital FT
Mental Health
South West
London and St
Georges
Social Care
• E.g. could be
nursing home
& residential
care providers
Primary Care
• GPs
• Richmond
GP Alliance

12. Joint Commissioning Collaborative
Working towards a community and out of hospital
services contract in 2016
Health
Prevent-
ion
Primary
Care
Mental
Health
Acute
Care
Social
Care
Current HRCH
community
services including
(not exhaustive):
• District nursing
• RRRT
• Diagnostics
• Rehabilitation
• MSK
• Diabetes
• Podiatry
• Paediatric
services
Community
Services
• HRCH
• Your Healthcare
Community and out of hospital services Service providers
Acute care
• Kingston Hospital
• West Middlesex University
Hospital
• Chelsea and Westminster
Hospital FT
Mental health
• South West
London and
St Georges
• East London
Foundation
Trust
Social care
• E.g. could be
nursing home
& residential
care
providers
• Voluntary
sector
Primary care
• GPs
• Richmond
GP Alliance

13. Joint Commissioning Collaborative
Outline contents of Re-commissioning launch document issued by CCGs:
May 15 June 15 April 16
Release
assessment
criteria
Route A: Coordinating provider development
Contract
commencement
Capability
Assess 1
Pass
Capability
Assess 2
Pass
February 15 December 15
Release future
contract for
capability
assessment 2
Route B: Open market procurement
Fail Fail
Timeline for 2016/17 OBC contract

14. Joint Commissioning Collaborative
Impact on patients
• Patient outcomes are the basis of care plans
• Patients have more information with which to make
decisions
• People can do more self-management and self-care
• Greater emphasis on prevention and early
intervention
• More care delivered at or near home
• Better value for money