Health Service Focus


Making place-based commissioning a reality with digital

Source: NHE May/Jun 17

During e-Health Week a panel of experts discussed the benefits of place-based commissioning. NHE's David Stevenson reports.

Back in 2015, The King’s Fund published its ‘Place-based systems of care: A way forward for the NHS in England’ report. It argued that NHS organisations need to move away from a ‘fortress mentality’ and that collaboration through place-based systems of care offers the best way to tackle the growing challenges facing local health economies. 

During a recent panel discussion on using digital to make place-based commissioning a reality, Dr Michael Dixon, chair of the College of Medicine, who is a strong advocate of social prescribing, said his challenge to technology and suppliers was to work better for patients. 

“The chance for digital will be to offer the transactional services where appropriate, and supplement and support personal services where it is necessary,” he said, adding that as we move towards place-based care the patient is “no longer people we do things to, they become part of the provider system”. 

Dr Justin Whatling, vice president of population health at Cerner, told delegates at e-Health Week the NHS has a good opportunity to learn lessons from the US and “develop place-based care where it is a lot more holistic within individual geographies for how they join up the experience for the citizen, but also the professionals working in that care system”. 

“I think we are going to see a bit of a shift from documentation systems into planning systems, and then integrating planning systems of citizens and professionals working well together,” he said. “We will see a shift with this intelligence, and technology has a huge opportunity.” 

He also reflected on the Nuka Care experiment in Alaska, which included a whole-system redesign which has broken down barriers between primary care, community services, mental health services, and hospital specialists. 

“It was a huge change to get there, but it’s the sort of thing the Five Year Forward View (FYFV) is talking about with clinician hubs serving 30,000-50,000 people,” said Dr Whatling. 

“I think a lot of people are designing new care models, but they are being held to account in the old way of working while being asked to do the new way of working. The answer to that has to be local innovation, but they need to be supported on that journey. The next step of the FYFV is trying to make that a bit clearer, and as we move to accountable care organisations (ACOs) the centre will help and relax some of these things. 

“My view on sustainability and transformation plans (STPs) is that they are there to transition and help incubate ACOs.” 

NHS doctor and global healthcare IT strategist Dr Saif Abed added that, taking technology out of the equation, any form of reform in healthcare, whether successful or not, comes down to a few words: “people, processes, incentives, funding, support and leadership, and last but not least, politics”. 

“Technology is an enabler, but on its own is simply not enough,” he said, adding that it is incumbent on all of us in the system to take a longer-term view. 

“We can’t be short-termist or have a fortress mentality – we can’t simply focus on what is good for my organisation any longer. STPs, as they stand today, are documents. It is about people, processes and execution to make them work. And to give them the time to actually work,” argued Dr Abed. 

“There will be hiccups, there will be challenges; we have to expect those and get through with them. 

“But it is dependent on the people, the processes and the leadership and not least technology organisations that will ultimately make placed-based commissioning a success.”

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