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Procurement can be a catalyst for system working

Sara Bainbridge, head of policy and delivery at NHS Clinical Commissioners, discusses some of her organisation’s work on integration and the long-term plan, and shares some practical examples.

The NHS Long-Term Plan has confirmed that integrated care systems (ICSs) will be central to the future of healthcare in England by being the way to achieve the “triple integration” of primary and specialist care, physical and mental health services, and health with social care.

Clinical commissioners have been working on integration and taking a larger-scale perspective for some time now, as highlighted in our 2017 publication ‘Steering Towards Strategic Commissioning.’ Even then, clinical commissioners across the country were already developing integrated models of care and working more collaboratively with partners across a bigger footprint than a single CCG – and had the appetite to do more.

We wanted to follow up this piece of work to find out about how providers and commissioners are working together in a context where systems and strategic commissioning is becoming more prominent, and some providers are taking on activities that have previously been carried out by commissioners. The resulting publication, ‘Driving Forward System Working,’ was published in December.

Although this way of working is still at an early stage, clinical commissioners and providers agree that it is the right way to work as it brings opportunities to deliver efficient, high-quality care across a local system.

There are some (theoretically) simple ways to help make this work, such as having strong local leadership, taking a ‘bottom-up’ approach, involving all system partners in decision-making, and making sure they are all on the same page to have “one version of the truth.” We heard that focusing on the clinical outcomes was important.

To help facilitate collaborative working, underpinning governance, financial, and contractual arrangements can all play a part. The system leaders we spoke to acknowledged it is essential that partners continue to fulfil their respective statutory duties.

In Luton, for example, we heard that the CCG and local authority formalised their joint working with a ‘concordat.’ They have co-designed and procured an integrated wellbeing service called Total Wellbeing Luton, bringing together social prescribing, healthy lifestyle services, and improved access to psychological therapies into a single point of access, delivering integrated holistic care focused on the needs of the individual.

In some systems, procurement acts as a catalyst for collaboration. When Hillingdon CCG wanted to procure musculoskeletal (MSK) services, the procurement exercise prompted the Hillingdon Health and Care Partners alliance (which includes hospital services, primary care, community and voluntary services) to partner with its local Academic Health Science Network to assess the local population’s needs and spell out what a new service could look like. This brought different parts of the system closer together and transformed the MSK pathway in the area.

However, other leaders in England told us that procurement can mean that CCGs are inclined to put contracts out to competitive tender when this is not always necessary, causing delays and ultimately undermining system working.

So whilst many systems are forging ahead with collaborative working and using procurement as a way to achieve this, others tell us how important it is that there’s a fresh look at procurement and competition rules to avoid time-consuming and costly tender processes when the provider is performing well.

We were reassured that the NHS Long-Term Plan included a proposal to “cut delays and costs of the NHS automatically having to go through procurement processes” as part of their suggestions for potential legislative change, but we would warn against relying on primary legislative change as the means to achieve this.

A new Health and Social Care bill would prove a distraction, so it’s important to reassure commissioners about when they can make the most of flexibility in the current Health and Social Care Act – as per the 2017 guidance from NHS Improvement that, in the right circumstances, providing services ‘in an integrated way’ can outweigh the requirement to put them out to tender.

As these ways of working evolve and emerge, we’re looking forward to clinical commissioners continuing to play a leading role in system working – and finding even more collaborative ways to improve services for their populations.

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