Health Service Focus

04.09.19

What commissioners need to transform healthcare

Source: NHE: Jul/Aug 19

Dr Graham Jackson, co-chair at NHS Clinical Commissioners, outlines how CCGs can best deliver the goals outlined in the Long Term Plan and perform at their highest quality.

Speaking at the NHS Confederation’s conference last month, Simon Stevens, highlighted the need for change in the NHS’s service model. An ageing population, alongside more people with multiple or long-term conditions, means the system is outdated. It must be brought into the 21st century. But the question is how? 

The Long Term Plan (LTP) continues to drive transformation to make care more joined-up and person-centred, providing better and more timely treatment. But it also presents challenges for clinical commissioning groups (CCGs) and systems, both short- and long-term. 

Clinical commissioners will be on the front line of this change to service models and will themselves be working differently to deliver the ambitions of the LTP. For a number of years CCGs have been clear that a more strategic approach was the route to take, planning and buying services for larger populations whilst working more collaboratively with provider organisations; which will be embedded in integrated care systems (ICSs). For many, this also means the formal merging of CCGs over the next two years – building on existing collaborative arrangements where many CCGs are already sharing management teams. 

NHS Clinical Commissioners, as the membership body for CCGs, is working with NHS England and Improvement to set out what a streamlined CCG might look like – what activities might be done at ‘place’ or locality level, or what might be better for the ICS to take responsibility for. But with all this change, it is crucial that the unique strengths of clinical commissioners – the clinical leadership, system-wide perspective and strong links to the needs of local populations – are kept. 

Organisations working across ICSs are developing their five-year plans, building on work that has already been happening in many areas, but there are some things that will help them to deliver these plans by 2024. 

First, knowing which of the many tasks in the Long Term Plan should be prioritised. NHS England and Improvement’s Implementation Framework provides helpful clarity on this, whilst allowing flexibility to complete the rest according to local need, making sure the long-term goals are met. However, the scale of the challenge should not be underestimated. These goals are very ambitious; there must be an understanding and support for those systems where it may take longer than five years to reach them. 

Understandably, another of the main concerns is money. Helpfully, the Implementation Framework sets out what funding is available above CCG allocations. Clinical commissioners now know what additional resources will be available and, crucially, how to access them. It remains to be seen whether these additional resources will be enough. 

In addition, there are several changes to legislation that could speed up and smooth the path to integration, including reforming the payment system, sharing responsibility for health outcomes, clarity on accountability and governance structures, and revising procurement and competition rules. There is appetite for these both among our members and across the wider, but it is important to note that changes to legislation are not essential pieces of the puzzle. Which is fortunate, given the current political uncertainty that means it is unclear when – or even if – the law will change. 

Support centrally – from NHS England and Improvement, the Department of Health and Social Care and others – will be necessary to deliver the LTP’s ambitions. We mustn’t reinvent the wheel either; CCGs must learn from each other, share experiences and spread good practice. We will work to support our members commission for the future, in an architecture that seeks to create a multi-faceted, collaborative, more resilient base at different scales within a geographical area – whether through developing partnerships with local authorities at ‘place’ level or through Primary Care Networks at neighbourhood level. 

The building blocks are changing, the delivery model is evolving, but the focus of the LTP is clear: clinical commissioners must continue to strive for high quality, value for money outcomes as they always have.

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