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A commissioning checklist - ensuring you know your supplier, and vice versa |
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Medical Director, Bupa Commissioning |
Dr Henriette Coetzer |
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Thanks to recent changes in the procedures for agreeing contracts under the framework for procuring external support in commissioning (FESC), the length of time that this process now takes has significantly reduced. This can help PCT commissioners who choose to do so to take the opportunity to consider the kind of partner - and indeed the kind of partnership - they would like to have. So what follows here is an attempt to set out a checklist of some key questions and areas for consideration around a potential commissioning partner. 1. Do we know what we want? This may sound vastly obvious. Indeed, it should be crystally clear from your Local Delivery Plans and also from your preparation for the world-class commissioning assessment programme if there are areas in which you feel you could usefully buy in some support, training or resources. Commissioning is about your specific local needs – those of your population. The Darzi reviews of every strategic health authority have helped establish region-wide priorities, but your commissioning is – and must be – local. Therefore your FESC wants and needs should fall out of your established local priorities. A range of data is available from a variety of sources, including the NHS Information Centre, which you can be using to benchmark your performance and health outcomes. Which leads neatly to the next question, namely: 2. Are our outcomes good enough? National priorities, with targets and National Service Frameworks, have changed the processes of healthcare significantly. The next step in the journey of healthcare improvement is around health outcomes. Process measures alone will not prove likely to significantly raise health outcomes. Improving health outcomes relies first and foremost on accurate data and a culture of measurement and comparison. As the Department of Health’s world-class commissioning team have repeatedly made clear, nobody is being forced to use external suppliers to support commissioning. Some PCTs have invested significantly in internal staff, training and technology. Others have chosen to work with partners under the FESC. Others again may consider they don’t have a need. Any of these approaches may be right for you locally: it all depends on your circumstances. Your circumstances depend on your health outcomes. 3. What is on offer? Window-shopping, either in the traditional way or the high-tech online version, doesn’t commit you to a purchase. The same is true of looking at what external companies may be able to offer you in commissioning support or training. In the words of the old adage, ‘you don’t know what you don’t know’. Equally, PCTs in many health economies have already started to work together with neighbouring organisations, and to share expertise and even resources. They are also beginning to share knowledge of the products available to them. This is helping to develop an understanding of the available help and support that you may want to access. 4. Does my supplier listen to me? And do I listen to them? Listening – the two-way street version - is crucial in any relationship. If it is to be successful and mutually beneficial, commissioning support should be seen as a relationship. It would not be unfair to say that in much of the NHS, ongoing relationships with independent-sector providers have not always been a strong point. There have probably been faults on both sides of this situation – both in cultural terms, and in terms of expectations. There are no magic wands available in the independent sector that can perfect commissioning at a stroke. Despite the ‘world-class’ language, this fact is well understood by the very top level of the DH’s team. Yet there are unquestionably skill-sets and experience available in the independent sector, if the NHS wishes to make use of them. If you reach the stage of negotiations with a potential supplier, it is crucial to think about the mutual listening. They should (and hopefully will) be receptive to your wants, needs and indeed concerns. Equally, it may be beneficial to think about how you listen to them – critically, of course, as you are spending public money. Wider experience in business suggests that changing suppliers and adopting adversarial There is a balance to be struck to achieve intelligent commissioning – and it starts in how you would work with your supplier, and they with you. 5. What is my supplier’s track record? This is another very important aspect, under which a further range of questions sit. · Does your supplier understand your conditions in the local health economy? · Have they worked with the NHS before, and what was that experience like? · What can they demonstrate in terms of health gains, quality improvements or cost · Have any gains, improvements or savings been sustained over time? · How can they support the development of health outcome measurement? An emerging science Commissioning is an emerging science. This list does not pretend to be comprehensive or exhaustive. It is offered as a starting point, to help in thinking about your wants and needs.
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