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Developing Commissioning Policy

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  1. Developing Commissioning Policy Anthony Kealy Policy Directorate Commissioning Team

  2. Issues • Context of NHS reforms • The current position • Commissioning policy framework • Update on key work streams • Project plan • Engagement and communication

  3. Health Reform in England: update and next steps NHS System Rules for 2006/07 Practice Based Commissioning Guidance Commissioning Policy Framework Dec 05 Jan 06 Jan 06 Jul 06 Context of Reforms

  4. Framework for the Reforms Money following the patient, rewarding & incentivising providers (Transactional reforms) More diverse providers with freedom to innovate & improve (Supply-side reforms) Better care Better patient experience Better value for money More choice & stronger voice for patients (Demand-side reforms) Framework of system management, regulation and decision-making (System management reforms)

  5. The Current Position • Practice Based Commissioning rolling out • Universal coverage of PBC by December 2006 • Payment by Results in place • Review of specialised services commissioning • Joint commissioning review

  6. Commissioning Policy Framework • A comprehensive policy framework and implementation guidance covering: • The range of commissioning functions • Practice based commissioning • Specialised services • Joint commissioning • Rules of engagement • National / Regional infrastructure • Potential role of private sector

  7. Key Work Streams • Three consultancy reports submitted: • Improving Purchasing of Clinical Services, Price Waterhouse Coopers • National Settlement System & Financial Resource Management System, Flute Consulting Ltd • Creating a Market for Commissioning Services, McKinsey

  8. Improving Purchasing of Clinical Services • Regional Purchasing Centres, aligned with SHAs • PCTs will hold a single contract with their PC • Agreements and reconciliation arrangements between PCs to cover choice and specialist out-of-region commissioning • PCs work through National Settlement System

  9. NSS and FRMS • NSS – a single national payments engine • Will aggregate all activity transactions and reimburse providers, operating on a weekly payment run • Development / procurement now progressing • FRMS – tool to understand financial performance and model impact of commissioning decisions • PCTs would choose accredited provider • Work to be taken forward through commissioning project

  10. Creating a Market for Commissioning Services • Need for stronger technical commissioning skills: eg financial discipline, negotiating, contracting, actuarial • Could support payment/settlement, data analysis and disease management programmes • A range of business models from full-service to individual service lines • Action would be required to create a sustainable market • Work to be taken forward through commissioning project

  11. Commissioning Project Plan • Define Commissioning and describe requirements for each of its component functions • Develop guidance/rules on key policy elements: • Practice-based commissioning • Specialised services commissioning • Joint commissioning • Identify case studies of innovative approaches and good practice • Develop a framework of incentives, levers and sanctions for effective commissioning at all levels

  12. Commissioning Project Plan • Develop infrastructure to minimise bureaucracy and transaction costs, eg: • NSS and FRMS • Regional purchasing centres? • Develop/review model contracts and SLAs • Identify information requirements • Secure the range of skills and capabilities required for effective strategic commissioning • Link to PCT Diagnostic and development programme • Consider role of private sector

  13. Engagement & Communication • DH project group, involving all key stakeholders • NHS reference group • Engagement with other forums (like this one)

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