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World class commissioning

Physio at work In our second article in the latest Policy in Focus series, we take an in-depth look at a relatively new concept that will probably be familiar by name to most physiotherapists.

But just where did world class commissioning come from and what will it mean for the profession, for health and well-being services and for patients?

Reports and research by Matthew Limb

What is it?
What does it mean for physiotherapy?
Why has it been introduced?
What are the opportunities?
Pros and cons
What do physios need to know?
Further info

What is it?

The Department of Health and the NHS launched the world class commissioning programme in December 2007.

Its vision was to transform the health and well-being of populations, under the slogan ‘adding life to years and years to life’. It emphasised a more strategic, long-term approach to commissioning, designed to deliver improved outcomes based on expert analysis of people’s needs.

The programme’s title reflects an aspiration that commissioning bodies, particularly primary care trusts, should continuously improve their effectiveness.

The characteristics of excellent, or world class, commissioning are spelled out in a set of 11 competencies. These rate how PCTs: lead the NHS locally; work with community partners; engage with public and patients; collaborate with local clinicians; manage knowledge and assess needs; prioritise investment; stimulate the market; promote innovation; deploy procurement skills; manage the local health system, and make sound financial investments. A 12th competency on efficiency is also to be introduced.

PCTs are being judged on their performance by strategic health authorities, which oversee an assessment or assurance system. This system reviews and scores PCTs against long-term strategic objectives and measures three main categories: health outcomes, competencies and governance.

In future, underperforming PCTs could suffer sanctions such as being put under new management.

What does it mean for physiotherapy?

The WCC programme recognises that the health service is not the only player when it comes to improving health and well-being outcomes.

It offers a way of reshaping services and achieving a more integrated approach, tying in the contribution of the health service to other activities that engender health and well-being, whether operating within or across the public, private or voluntary sectors. Since 1 April 2008, local authorities and PCTs have been under a statutory duty to produce a joint strategic needs assessment.

The process seeks to establish the current and future health and wellbeing needs of a population with a view to improved outcomes and reductions in health inequalities.

When in 2005 the Department of Health published Commissioning a Public-led NHS, it concentrated on the structure and process of change.... it’s now time to focus on vision and content

Mark Britnell, Director general of commissioning and system management, department of health.

For physios and other health practitioners this could mean doing things differently and collaborating in new service models with a range of partners, such as teachers, leisure workers or criminal justice system professionals. It could allow llied health professionals to fulfill their role as integrators of care who can view the entire health and well-being journey, signpost it for the user and pull together
the necessary support services or provide these themselves.

PCTs are now looking to improve outcomes in line with their SHAs’ priorities or strategic visions,
which centre around eight or nine clinically led care pathways identifi ed in the NHS Next Stage Review. By recognising the value of
the care pathway approach, the WCC programme puts AHPs in a position to implement that for the benefit of the service user.

Over time, there could also be significant implications for the physiotherapy workforce, as commissioning increasingly
determines the shape and nature of the workforce. Should outcomes improve as intended, people’s ongoing needs may also change
and require different configurations of services and numbers of professionals.

Why has it been introduced?

Commissioning has for some time been considered the weak link of the health reforms.

Since the internal market reforms of the early 1990s, provider units have become increasingly powerful, leading to the development more recently of foundation trusts.

Now that the health service in England is embracing full-blown competition, commissioners held the purse strings and are thus in a position of power, which they are being encouraged to use appropriately.

Improving quality – defined as safe, effective and patient-centred services - was at the heart of the NHS Next Stage Review, led by health minister Lord Darzi. Improving commissioning is regarded as central to delivering this agenda. The WCC programme acknowledges that the standard of commissioning is variable and needs to improve. The policy is part of a wider agenda of reform designed to deliver better quality across the public sector, such as local authority and welfare services.

Within healthcare, earlier efforts to engage frontline clinicians in identifying the needs of local communities, designing services and managing resources accordingly, led to the policy of practice-based commissioning being put on a formal footing in 2005.

The WCC and practice-based commissioning programmes are linked. Practice-based commissioners are seen as having a key role to play at all stages of the commissioning process, including in supporting PCTs to decide local priorities.

By collaborating, local clinicians are meant to use their collective purchasing power to improve outcomes.

What are the opportunities?

Physios have as good an opportunity as any other professional group to prosper in the reformed world of commissioning. PCTs and SHAs now have a clear incentive to encourage innovation on the part of all healthcare professionals.

Indeed physios are particularly well placed to thrive, given their central role in many care pathways and in multi-agency and multidisciplinary teams. Some physio services are already demonstrating their effectiveness through collecting good quality data, and this is a paramount requirement as commissioners look for evidence of what will demonstrably improve health and well-being.

Karen Middleton, chief health

Pros and cons

Potential benefits

Better outcomes so that people have better quality of life [in terms of health] and live longer
reduced health inequalities • change in the expectation of what the NHS is about
NHS investment decisions based on evidence • delivery of improvements within available resources
more patient choice
improved access to services

Concerns

PCTs may lack skills and resources to deliver success
success from similar programmes overseas not proven
long-term uncertainty of marketdriven system

What do Physios need to know?

Physio helping patient Physiotherapists - whether in the NHS, the private and independent sector, or in primary or secondary care - first need to understand the needs of their populations and articulate how they can provide the solutions to improve people’s health and well-being. They will also need to collect data and show evidence for the effectiveness of their solutions.

For physios wishing to engage with commissioners, the first point of contact may be through their organisations’ business managers.

Gary Robjent, CSP head of policy and public affairs, says: ‘Whether we like it or not, the environment in which physiotherapists and other health and well-being professionals operate has changed.

‘Commissioners will look to those who can best demonstrate and articulate the solutions they can offer in terms of safety, clinical effectiveness and user experience.’