PCTs Commissioning from FTs Network Meeting

Held on 9th October 2006at Islington PCT

Attendees

Trudy Affleck, South Wiltshire

Harriet Agyepong, Lambeth

Tim Boxer, Preston

Paul Carney, High Peak & Dales

Mark Chidgey, Stockport

Stephen Conroy, Camden

Felicity Cox, NHS Networks

John Doherty, North Sheffield

John Dowell, Exeter

Simon Goodwin, Islington

Sebastian Habibi, DOH

Anthony Kealy, DOH

Neil Nicholson, North Tees

Trevor Myers Thurrock

John Nickson CFH

John Offord, Huntingdonshire

Sheenagh Powell, Craven, Harrogate & Rural District

Jill Peters, DOH

Ged Taylor, North West SH

Jan Thompson, Bradord South West

Alison Tonge, Stockport

Sue Trendall, Hampshire

Peter Wightman, Huntingdonshire

Harriet Livesey DOH

Elaine Biglen, Stockport

Alison Tonge opened the meeting by thanking the key speakers from the DOH for coming along to talk about the latest policy update and encouraging everyone to participate with their practical experiences.

Anthony Kealy spoke first on the Commissioning Framework. The key points being:-

There would be a health reform update in November

Future of PbR – this would be issued in the Spring of 2007

Main themes: better clinical and community engagement (through PBC)

Procurement Rules – No tendering generally expected for PBC driven development

PCTs would be encouraged to use the locally enhanced services, only tender when in a monopoly situation

VFM, clinical effectiveness, business case is sound

Business case is important to have in place first.

Latest Policy Update and feed into our practical experience all going through change.

A. Kealy – Health Reform in November.

Next Stages: Future of PBR – Spring 07

Commissioning Framework

Themes: Better clinical and community engagement (through PBC).

Tariff approach – Pathway change

Address the feedback on clinical governance.

a)New PCT prospectus)

b)Role of LINKS)

c)Third Sector involvement ) December

d)Proposals of Triggering community action. Joint)framework

prospectus with the LA)

e)Through petitions)

Strategic Needs:

Better Information to support commissioning

Sets out the approach to improving information.

-Using the insights provided by patients, providers, comities of local authorities.

-Developing strategic solutions such as CFH, SUS, December framework and what and how to do it.

Incentives & Contracts

  1. Using open tendering to contract new providers where the services are unavailable or of poor quality.
  2. No tendering requirements for PBC development.
  3. Using the limited finance incentives and activity guarantees where appropriate.
  4. Makes proposals for a national model contract future of secondary care contracting - End Nov.

Levers in contract – Quality essential (QOF).

Securing a cash limit

  1. Referral management, prior approval, and utilisation management alongside Choice, PBC & PBR.
  2. Applying interim measures permitted by the operating framework in exceptional circumstances: (SHA defined)

Clear activity assessments of financial responsibility. Clear apportionment of financial responsibilities where the balance is at risk.

MONITOR to agree

Benchmarking/FT and re quality of the information supporting this.

AT: New contracts/tensions – we need the support for these new contracts.

Developing Capacity & Capability

  1. PCT development, building on Fit for Purpose.
  2. Developing an individual base of effective commissioning.
  3. Development of PBC
  4. Supporting PCT’s, buy in private sector skills

30 short listed of the procurement – Dec. Framework, Where is the infrastructure for PCT’s and how do we support them? We need problem resolution approaches.

Need to inform MONITOR what we expect them to do.

Next Steps

  1. Engagement with the NHS via SHAs
  2. Development of national model contract
  3. Final guidance on: -

a) Contracting for NHS care

b) PBC governance and accountability

c) Triggering community Framework

5.Phase 2 of the Commissioning Framework

S.HabibiPbR

07/08 & Beyond

07/08 Tariff setting processes – fixed

Keep the same price now. testing 6 wk.

Period to road test. Mid December.

08/09 – New Year PBR

All need to include stakeholders. MH, HRG’s & Acute HRG’s. (Peter Spilsbury, W.Mids to chair this group).

Strategic Priorities

  1. Commissioning & Provider
  2. Normative pricing, explaining the scope risk sharing.
  3. National framework for evaluation.

Relative Priorities

Normative Pricing – Productivity evidence of best practice, technical ability, drive down national tariff

–looking at the NHS Institute

–Top data

–Tariffs, pre assessments, episodes

Attendances – ‘package of care’ – pathway tariff, cross subsidy between income for routine and complex costs. How do we count things better?

High Cost – Pathways

Review benchmarking:

07/08 – Work with clinical, nominative length of stay.

Excess Bed Days – guidance – Board meeting on 10/10 to discuss this.

Benchmark costs for diagnostics next year.

Sept: Align Finance Incentives.

1)Pay for performance: Quality incentives – contract or tariff.

2)Application to a plurality of providers – casemix activity

3)Developing a market for a specialist in managing LTCand risk – capitation

Small hospitals are being hit – no national models.

Ceiling – number of patients or value is this a valid approach

PCTs pay for the activity. Accurate coding leads to pressure, options for deflator discussed or ‘reasonableness’ of this movement.

The DOH need to tie up the definition. The Audit Commission have identified huge variations in charging policies for setting of delivery. The clinicians are now coding. They may need to be addressed by clinical data. Indicators should be set.

Need a process further than the Code of Conduct. Casemix – audit – what do we do with the results? . coding movements should be risk shared – as a quality improvement rather than a PCT cost.

Benchmarks

Mutual confidence in the clinical prices on going development of PbR models

Code of Conduct was supported and further systems to enforce and support PCT’s

in particular the issues of modality for recording of procedures/HRG’s and lack of guidance

Main points: Coding, MONITOR, Benchmarking, November, December/Spring papers

SUS – John Nickson

April 07 for A&E calculations and dataflows

Data definitions – problem with well babies and Rehab

Quarter 2 – coming out Friday 6th Oct.

PbR UAG – mike Foster

June 07 – Benchmarking – Risk/Performance

Procurement – Specialised skills for commissioning – Jill Peters

Jill presented a paper describing what was expected from new providers, 30 of which had been shortlisted.

Micro/end to end /macro providers for the specification of services to be agree by December 06

The risk element would be with the supplier for delivery to standard, national consideration of how far risk transfer will go.

risk transfer to national suppliers for commissioning yet supporting PBC requires consideration

Bidders – evaluation criteria

1) Workforce, CE and commercial experience

2) Final list

3) Risk

4) Final contract – proposal – evaluate that

5) Short list – this will then go out to PCTs

Pilots for all 3 – how is it going to work in practice?

It was noted that leaders of LAs had not been engaged at all.

Commissioning Support Unit in London

Alison Tonge – 18 weeks & Demand Management penalties for new contract

Handed out a proforma, which she had completed and wanted to discuss it with the group and have their comments. It would be emailed out to everyone. It was important to get a cohesive message to the DOH from the PCT perspective.

Discussed when an admission is an admission.

What is best practice – evidence based.

Next Meeting

To be arranged – January 2007

To be hosted by Paul Carney, High Peak & Dales PCT.

[NB. HighPeak and Dales PCT is now part of DerbyshireCountyPCT.]