Healthcare Commissioning

By Catherine Mountford and Ian Bottomley, Oxfordshire Clinical Commissioning Group

CCG’s are required to commission services from providers to meet the needs of their population. Their focus is about improving the overall quality of services for individuals and the health of the population. 

The act of commissioning involves a transaction – if we don’t know what we are getting and what it costs we cannot know if we are receiving value for money. This transaction has led to much discussion about “the market in healthcare” and leads us to ask questions such as:

• Does “the NHS” mean free at the point of use AND/OR provided by “the NHS”?
• What do we mean by the market, is it
  • Having financial transactions?
  • Having competition?
  • Contracting with the “private sector”?
• Who is the private sector? For example, GP practices are small private businesses but most people would consider them “NHS”. 

In Oxfordshire we wanted to develop a contract that focused on the outcomes achieved for patients, not the inputs or activity count. It would cover all services (and hence providers) and be used to align incentives and encourage integration. To give providers time to work together to deliver changes the contract length would be a minimum of 5 years. The CCG is the “payer” on behalf of the end user, the patient so we ensured we involved users and carers in the development of the outcomes and metrics thinking about “what is important to you to enable you to live your life as independently as possible?” Users and carers both framed their responses in terms of “what keeps me well” and “how can I live with a sense of hope, purpose and ambition”. The high level outcomes we agreed are:

• People will live longer
• People will improve functioning (they will cope better with their illness)
• Timely access to support
• Carers will feel supported
• People will have a meaningful role
• People will have stable accommodation
• People will have better physical health

Each outcome has one or more defined indicators to underpin it.

When making decisions about securing services the CCG must work within the rules which are included in “The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013”,

1) Act with a view to: securing the needs of the people who use the services;

improving the quality of the services, and improving efficiency in the provision of the services, including through the services being provided in an integrated way (including with other health care services, health-related services, or social care services).

2) Act in a transparent and proportionate way, and treat providers equally and in a non-discriminatory way, including by not treating a provider, or type of provider, more favourably than any other provider, in particular on the basis of ownership.

The relevant body must procure the services from one or more providers that are most capable of delivering the objective referred to in regulation 2 in relation to the services, and provide best value for money in doing so.

3) In acting with a view to improving quality and efficiency in the provision of the services the relevant body must consider appropriate means of making such improvements, including through— the services being provided in a more integrated way (including with other health care services, health-related services, or social care services), enabling providers to compete to provide the services, and allowing patients a choice of provider of the services.

Our approach to securing services considered these regulations and the market/availability of health providers of these services in Oxfordshire. This led us to determine that we wished to ask the current providers to work together to provide a proposal as to how they would deliver they outcomes we were asking for; we called this “Most Capable Provider Process”. This was an assessment approach that could be failed.

Our local NHS provider is acting as the lead provider with a group of five voluntary sector organisations. They submitted an exciting proposal and we are now finalising the contract and looking forward to improved service integration and most importantly outcomes for patients.