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Practical integration of commissioning: where to start and where to go |
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Consultant and National Director - PBC Federation, NHS Alliance |
Julie Wood |
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At the moment, it feels as if PCTs’ commissioning heads are heavily immersed in the world-class commissioning process, especially in the assurance process leading up to assessment. It also feels to people working at the front line that practice-based commissioning (PBC) has been carrying on at the same level of implementation that we’ve seen over the last year. Yet both Lord Darzi’s High-Quality Healthcare For All and the Department of Health’s (DH) new primary and community care strategy emphasise the importance of PBC. The DH world-class commissioning team, led by Mark Britnell and Gary Belfield, have made it clear that it’s a priority of theirs to re-energise and reinvigorate PBC and that’s really good news!. This gives us a chance to review whether the processes, timescales and resources available for PBC enable it to play a full in part in progressing the development of commissioning. Playing a full part If PBC is to play a full part in helping PCTs deliver against the world-class commissioning agenda, then this reinvigoration is needed sooner rather than later. It’s time to ensure we have the basic ingredients for PBC, and that the environment within which PBC will flourish is in place. In the culinary metaphor, if you’re trying to work in a very cluttered kitchen, without the right utensils ready and lacking an orderly way of developing the recipe, you’re probably going to end up with an unsightly and unappetising dish. As well as having the right ingredients for PBC, we need the ‘master chefs’ in place. Over the past 15 months, we’ve been working with Humana Europe to develop the NHS Alliance / Humana PBC Academy. The PBC Academy provides practical knowledge, skills and training for front-line clinicians on the essentials they need to do PBC. The course modules are 11 half-days, and the content is very practically focused to give people the information and skills to improve their commissioning and to make an impact on service change. The modules answer a range of PBCers’ questions, including: · If I have a good idea for service, how do I know it’s worth doing? · How do I understand the needs of my practice population, and balance them with those of the wider PCT population? · How do I know which clinical areas I or my PBC group should focus on? So far, the Academy has been piloted in 2 SHA areas. It is now rolling out in a third SHA and two other health communities, with more coming on line over the next few months. Independent evaluation has shown that all modules have given participants an increase in confidence about their knowledge and skills to do the job. Feedback from participants has been highly positive, particularly about the Academy’s practical nature and how it specifically meets the needs of very busy PBCers. Four key ingredients There is no doubt that commissioning in general, and PBC at its heart, need to make progress now. There are four key ingredients for success: Relationships are crucial, because without the right relationship, you can’t deliver. What’s needed is a ‘critical friend’ relationship – where the parties don’t always agree with each other, but always respect each other and know they’re both in this for the same reason - albeit as two sides of the same coin. Vision – a shared and agreed vision is fundamental. If both parties are going in different directions and neither knows it, no progress will be made. You need an agreed vision of where you’re going, and of how PBC helps you to achieve that vision. Alignment – you also need a good alignment between the PCT’s processes and PBC processes. Without that alignment, the PBCers could be submitting business cases and wondering why they’re not getting supported when the processes are out of kilter time-wise, but also content-wise against the shared vision and basics. Without fresh activity to support the decision-making and likewise budgetary support for PBC, localities will not even have a shopping list for ingredients to start making their dish Proportionate governance – if you’re trying to make a simple omelette, you don’t need an 85-page recipe book. However, if you’re trying to deliver a lavish and sumptuous banquet, you may well need such guidance. Health economies need to formulate governance for PBC that is proportionate to the task(s) being commissioned if we are to support service redesign and focus on health outcomes. Heat and kitchens It gets hot in most kitchens, and as we know from the TV programmes, some of the best chefs can get a tiny bit aggravated if they don’t have the finest ingredients or the right utensils to deliver the dish. So it is with PBC. You need to be prepared, but you also need to be realistic. Other obvious pitfalls include trying to make your kitchen cater for more ‘covers’ than your staff can manage to serve. Double-booking is another risk. Above all, the ambitions for commissioning need to be realistic about what can be achieved in the very short term. If you’re a burger bar, don’t try to get three Michelin stars overnight ... but always hold on to those ambitions and formulate your plan for how you might get there! |
