Dr Chris Packham, RCGP Centre for Commissioning, on how public health specialists might help commissioners respond to the efficiency challenge.

1. Commissioning challenges:
relationships between public
health specialists and clinical
commissioners
Dr Chris Packham
RCGP National Commissioning Champion
GP and DPH

2. 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

3. 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)

4. NHS spend 1979-2010

5. 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

6. 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

7. 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!

8. Example
Geo-demographic profiling:
Mapping smoking
cessation activity by area

9. Superimpose high need groups

10. spot the gaps

11. Example

12. 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