Our aim is to improve outcomes for people with mental health needs. We plan to meet this aim by constructively informing central and local government policy that relates to our work, through positive dialogue with policymakers. We also work collectively as a sector in understanding developments in government policy and in discovering how our services might adapt to meet the requirements of policy changes.

Summary of response:

  • The NHS Commissioning Board should engage in genuine practical commissioning.
  • The Board should put robust governance structures in place taking account of the full clinical pathway.
  • The Board, along with GPs and providers should agree clear outcome measures.
  • There should not be breaks in care and low volume, high cost services should be commissioned on an individual basis with a focus on service user need.
  • GP‟s should be actively engaged in low volume commissioning to ensure that they are happy that the interface between specialised commissioning and local commissioning is clear, effective and without barrier.
  • GP consortia should be required to produce regular reports demonstrating clinical outcomes, good governance and value for money.
  • Where good practice exists, the Board should highlight it and encourage wider take-up.
  • The Board should refocus the NHS to a system that commissions services on behalf of a service user or patient.
  • Commissioners should make regular visits to sites where services are provided.

 

Responses to questions

Q1. In what practical ways can the NHS Commissioning Board most effectively engage GP consortia in influencing the commissioning of national and regional specialised services and the commissioning of maternity services?

1.1 The Board should engage in genuine practical commissioning. This should involve guidance on the commissioning of services along the entire pathway and including community services. This will lead to decreased costs and fewer gaps in funding.

 

1.2 The Board should also put robust governance structures in place. This should include transparent and accessible accounting records and take account of the full clinical pathway. Additionally, regional groups of GP consortia should be responsible for commissioning low-secure services and required to take the views of local authorities into account. Indeed, all commissioning should be undertaken on the basis of accepted best practice.

 

 

1.3 This should be underpinned by clear outcome measures. These measures should be jointly agreed by the Board, GPs, providers and local authorities. These groups should also focus on joint working supported by joint Key Performance Indicators. National standards already exist for medium secure services and could be replicated for other areas. These standards should have a service user focus to them and there should be a consensus on outcomes to prevent a postcode lottery.

 

Q2. How can the NHS Commissioning Board and GP consortia best work together to ensure effective commissioning of low volume services?

2.2 As mentioned above, the Board should have a focus on clinical pathways. There should not be breaks in care and low volume, high cost services should be commissioned on a consistent basis with a focus on service user need. The Board should also consider asking consortia to demonstrate competency to deliver services via an agreed accreditation process.

 

2.3 Low volume services should be commissioned in a consistent manner across the UK, and depending on volume some services should be nationally commissioned. Outcomes and expectations should be made clear and the any willing provider concept introduced, to push providers to strive to quality rather than quantity or the safety of a „block contract‟.

 

2.4 GP‟s should be actively engaged to ensure that they are happy that the interface between specialised commissioning and local commissioning is clear, effective and without barrier

 

Q3. Are there any services currently commissioned as regional specialised services that could potentially be commissioned in the future by GP consortia?

3.1 No. GPs should be involved in the regional board‟s decisions but breaking up pathways of care leads to inefficiencies.

 

3.2 The current system is patchy and inconsistent meaning lengths of stay in expensive inpatient care are increased because of system barriers rather than patient requirements. GP‟s could however usefully monitor the efficacy and performance of the system as care becomes delivered closer to the community

 

Q7. What safeguards are likely to be most effective in ensuring transparency and fairness in commissioning services from primary care and in promoting patient choice?

7.1 GP consortia should be required to produce regular reports demonstrating clinical outcomes, good governance and value for money. This should be supported by evidence of choice being given to patients over how, when and where they receive their care.

 

7.2 If outcomes from some providers are shown to be less cost-effective than for others, GP consortia should justify their decision to choose less cost-effective services.

 

Q8. How can the NHS Commissioning Board develop effective relationships with GP consortia, so that the national framework of quality standards, model contracts, tariffs, and commissioning networks best supports local commissioning?

8.1 The Board and consortia should work with providers to learn from those who have more experience in commissioning processes.

 

 

8.2 Where good practice exists, the Board should highlight it and encourage wider take-up. The Board might also consider a requirement that consortia implement some identified good practice in local commissioning.

 

Q9. Are there other activities that could be undertaken by the NHS Commissioning Board to support efficient and effective local commissioning?

9.1 The Board should list recognised, approved providers who meet credible and competent standards by developing an accreditation process. Approved providers should be those who can demonstrate long-term cost savings beyond simply reducing short-term fees. These providers should be subject to ongoing assessment and be required to demonstrate their quality, governance standards, outcomes, and value for money. This process should be overseen by Monitor.

 

9.2 The Board should refocus the NHS to a system that commissions services on behalf of a service user or patient. It should also remove systemic barriers that prevent “any willing provider” from delivering services.

 

Q15. Are these the right criteria for an effective system of financial risk management? What support will GP consortia need to help them manage risk?

15.1 Yes if they are supported by yearly published accounts and the Board reviews specific allocations with a view to examining trends over time. There should also be a statement of risk report published. This should be published in an accessible format that is easy for patients to understand.

 

Q19. How can GP consortia and the NHS Commissioning Board best involve patients in making commissioning decisions that are built on patient insight?

19.1 The Board must include some members without long careers in the NHS. It should be clearly separate to the NHS and separate to the provision of NHS funded services.

 

19.2 It should publish clear and concise reports of its activities. These should be open about any mistakes made and remedial action taken.

 

19.3 User groups should be involved in Board decisions in a way that goes beyond tokenism. Constant, publicly available user-generated feedback should be openly considered in decision making.

 

19.4 Patient choice should be made more transparent with reports on how a patient is offered choice and actively involved in decisions about their care

 

Q20. How can GP consortia best work alongside community partners (including seldom heard groups) to ensure that commissioning decisions are equitable, and reflect public voice and local priorities?

20.1 Clinical outcomes should be published online for all providers. A full list of measures taken to involve partners and their importance to commissioning decisions should be available. Reports should be accessible and jargon-free including a glossary of terms

 

 

20.2 The Board should take account of user feedback and work with service providers to develop quality improvement plans based on that feedback.

 

Q23. How can GP practices begin to make stronger links with local authorities and identify how best to prepare to work together on the issues identified above?

23.1 GP practices should be coterminous with local authorities. This will prevent people falling through the gaps in services. There should also be a duty on consortia to ensure that any gaps in services that develop are quickly addressed.

 

Q25. How can multi-professional involvement in commissioning most effectively be promoted and sustained?

25.1 All groups involved in commissioning should practice close and regular engagement with all parts of the service delivery sector. There should a broad range of expertise included on the Board.

 

25.2 Commissioners should make regular visits to sites where services are provided.

 

25.3 Where good practice of multi-professional involvement exists, it should be encouraged and taken up across the country.

 

Recommendations:

1. The Board should engage in genuine practical commissioning. This should involve guidance on the commissioning of services along the entire pathway and including community services. This will lead to decreased costs and fewer gaps in funding.

2. Low volume services should be commissioned in a consistent manner across the UK, and depending on volume some services should be nationally commissioned. Outcomes and expectations should be made clear and the any willing provider concept introduced, to push providers to strive to quality rather than quantity or the safety of a „block contract‟.

3. GP consortia should be required to produce regular reports demonstrating clinical outcomes, good governance and value for money. This should be supported by evidence of choice being given to patients over how, when and where they receive their care.

4. Where good practice exists, the Board should highlight it and encourage wider take-up. The Board might also consider a requirement that consortia implement some identified good practice in local commissioning.

5. The Board should list recognised, approved providers who meet credible and competent standards by developing an accreditation process. Approved providers should be those who can demonstrate long-term cost savings.

6. User groups should be involved in Board decisions in a way that goes beyond tokenism. Constant, publicly available user-generated feedback should be openly considered in decision making.

7. Clinical outcomes should be published online for all providers. A full list of measures taken to involve partners and their importance to commissioning decisions should be available.

8. All groups involved in commissioning should practice close and regular engagement with all parts of the service delivery sector. There should a broad range of expertise included on the Board.

 

For more information please contact Mihir Magudia, IMHSA Secretariat, This email address is being protected from spambots. You need JavaScript enabled to view it., 020 7227 1644