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NHS commissioning - a perspective wiki
Derek Miller, Director of Commissioning shares his experience of commissioning within an NHS primary care trust (PCT).
There are perhaps two main areas that nonprofit organisations can work with the NHS and either move into, develop or remain in the provision of healthcare services market. The healthcare market is significant and until the expected squeeze on public sector expenditure, there is still some growth in specific areas.
Specialist services
The first area can be described as operating in niche areas or providing new or specialist services that are not available elsewhere. There should be something special or different about your service. It might, for example, be targeted at hard-to-reach groups, or it might be a service that other organisations are unwilling to provide because it's uneconomical for them.
For example. under the umbrella of providing involvement in football games to drug users, my PCT funded an organisation that was able to provide advice and basic services to a group of drug users that would not normally access the statutory services.
So, the service has to be niche.
Starting a new service
Organisations can approach a PCT with their ideas, or set up a service up with donations or grants and then approach the PCT for ongoing funding.
It's important to be aware of key NHS targets, which include things like the number of substance misusers in treatment, reduction of alcohol abuse, reduction of obesity and the number of people tested for chlamydia. The important targets for the NHS are set out in the operating framework for each year.
Measuring performance on service delivery
One key aspect that must be considered when setting up the services is measuring the outcomes and performance management framework. These are technical issues which must be addressed. It is no good providing a fantastic service if the outcomes cannot be described and measured.
Effective measures need to be in place from the outset. A simple way is to use the SMART objectives formula:
- specific
- measurable
- achievable
- realistic
- timely.
Contracts
There will need to be a contract in place, but the process of agreeing the content should be straightforward. The PCT is required to develop the market and encourage a wide range of providers. For services with a relatively small value (generally under £50,000, but this depends on the PCT) there should be a short and simple contract in place.
General services
This is where a PCT or other NHS body defines the services that need to be commissioned for the health needs of the population. The provision of general services could, for example, include the provision of nursing home placements or community care or other specific types of services.
Commissioning process
The PCT should follow a commissioning cycle to consider need, review markets, develop appropriate performance arrangements and produce service specifications.
The PCT may produce an initial outline specification or vision, to which interested organisations must respond, before issuing detailed tender documents produced. You will need to follow the requirements in the documents closely and meet all the essential requirements. This may be obvious but there are so many examples of tender replies which do not follow the prescribed structure or do not include the basic documents.
Contracts
There will probably need to be a long, specific and detailed contract in place. Unless the organisation can provide the legal, financial and administrative support to finalise and assess the implications, then it may be a risky business being party to such a contract.
Working together on contracts
One potentially challenging area to address is joint working, which can include ad-hoc partnerships or subcontracting to joint ventures. A joint working arrangement can be permanent or set up just for the contract, but it does require organisations to work effectively together. The PCT will want to deal with one lead organisation. For the organisations involved, the key question is how much to co-operate and when to compete.
Organisation of the NHS
Funding for the NHS is allocated from the Department of Health (DH) mainly to PCTs. There are a number of other organisations and quangos who receive funds from the DH. These are all commissioning organisations.
Practice-based commissioning
One interesting set of very diverse organisations with varying complexity and responsibility are practice-based commissioning (PBC) groups.
The aim of PBC is quite simple and in some cases has proven to be effective: to provide clinicians with the responsibility and tools to manage all the commissioning budget on behalf of a defined population. However, the details and different methods of developing PBC have made it a complex and unwieldy process.
In some areas of the country there are effective PBC arrangements in place and GPs have the funds to commission services from the nonprofit sector. PBC groups may have a focused and quick response to enquiries and it may therefore be easier to contract with these groups.
Subcontracting opportunities
Governments have aimed to develop the market for provision of health care and encourage new providers to enter the market. The list of potential providers is quite long and includes NHS trusts, foundation trusts, private sector, third sector (nonprofit organisations and social enterprises), GPs (and GP consortiums) and PCT provider arms.
These organisations may subcontract to the nonprofit sector for certain services, such as translation services, and there will be specific tender documents for these services.
Useful links
Have your say
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