Do you understand the future of commissioning?
Scott McKenzie
NHS Industry Advice, Training and Management Consultancy. Strategic insight and troubleshooting for NHS providers, Federations, Networks, Pharma, Med Tech and Device companies.
This is one of the most common questions we get: what is the future for CCGs and commissioning as we move to Integrated Care Systems (ICS)?
Anyone believing that Clinical Commissioning Groups (CCGs) will no longer exist would be wrong in that belief. They will remain statutory organisations, with the same responsibilities that they have now. With there being limited appetite for the foreseeable future to make amendment to the Health and Social Care Act 2012 which brought them into being, CCGs will remain the statutory body responsible for commissioning. However, whilst their statutory and legal duties remain the same, there is no doubt that their role and function will change as we move forward into the world of ICSs.
Changes to the way CCGs function on a practical level are well under way, and most have now merged so that they align and collaborate with local authorities; we have moved from 209 in 2012 to 135 as of 1st April 2020. However, in terms of the pace of change thereafter, as we’ve said in our previous articles, this will vary from ICS to ICS depending on the level of maturity in each.
Whilst they will retain their statutory duties and function, the reality is that the commissioner/provider split is already starting to disappear as part of that shift into ICS. Ultimately their role will become very much like that of the old Strategic Health Authorities: the requirement for an annual commissioning plan, development of outputs, outcome measures and monitoring, along with oversight and management of system performance – high level, scrutiny, strategic and oversight. All other statutory responsibilities will be shared with ICSs, or devolved in their entirety, as the ICS demonstrates that it has reached a level of maturity where such responsibilities can be passed to them.
In terms of contracting, Payment by Results (PbR) is likely to disappear, with a return to block contracts already happening in many areas. PbR and block contracts are the current and most common methods of payment; however, they are likely to change to become an integrated budget or a single payment across the ICS. The constituent organisations will then need to work together to understand their population needs, the associated service requirements to meet those needs whilst considering prevention, and all within the envelope of funding that they have.
And what of those who work in CCGs and whose roles will no longer be required? Well, the need to understand service requirements and ensure delivery clearly hasn’t gone away, and we’re starting to see those in commissioning roles, as well as medicines management, move across to ICSs; what remains to be seen is how mindsets will change once in a different environment.
For you, as we’ve put forward previously (please see previous articles on how to map your local Integrated Care System:https://www.dhirubhai.net/pulse/mapping-your-local-integrated-care-system-scott-mckenzie/ and how to identify the right customer to work with: https://www.dhirubhai.net/pulse/finding-right-customer-key-scott-mckenzie/), it’s identifying the level of maturity of the ICS that’s local to you, doing your research, establishing who the customer is and engaging with those who are business-ready and in a position to work with you.
Scott McKenzie is an independent management consultant supporting GP Practices, GP Federations, Primary Care Networks of 30k-50k structure correctly to then deliver high quality patient outcomes with financially viable solutions. Scott is working to support the Pharma, Med Tech and Device Companies better engage and access the NHS. For more information on how we can support you please contact Frances on 0845 388 0302 or email [email protected]
Scott, A helpful overview, and certainly seems an eminently logical analysis given where the environment seems to be right now, though if you were to speak to 100 different healthcare leaders about what their definition of Integration was, i suspect it would certainly be a little 'opaque' right now (depending upon where people were sat in the system). If it wasn't for COVID-19, I saw changes to the Health & Social Care Act happening sooner than later, to align with ambitions of NHS England. To that end I would have foreseen an Integrated provision and commissioning model akin to Health Boards of Scotland and Wales or the Regional Health Authorities of Canada being the emergent organisational model, where everything from Primary care through to Tertiary Care would be under one management in given geographical economies. The downside of that model in Canada is definitely its disconnect with Social Care, which I would certainly not advocate. From my experience there is no perfect organisational form ... merely whats right at the time, and what suits a defined environment given the variables at the time. Key to any successful model is likely to be the defined drivers of the time ...i.e. whats driving the form? Or what behaviours are we trying to illicit from the system ... and from experience in government, this is a continuously changing feast, which in itself flies in the face of organisational stability required for long term success! A more fundamental question for me is "what do we want out of commissioning as a function?" If its purely about holding providers to account (for quality and standards of care, and VFM), is there a different way doing that? Inspection and Scrutiny is already separated at a national level through Regulators, so might there be some merit in exploring integrated Health & Social Care Regulators at a local level through Councils or Regional Assemblies? One thing is for sure, and that is the existing workforce capacity (and capability) across the H&S sector will be insufficient for future needs, so for me its not about removing or decimating organisations .... but more about optimally using this (and bolstering it) with more as well as using technological advances for improved productivity and efficiency. Its a shame that we keep going back round the same old organisational forms (i.e. a return to the old Strategic Health Authority way of working) as isn't the definition of insanity 'doing the same thing over and again whilst expecting a different result'? Just some observations and food for thought. S