Participation: its impact on services and the people who use them

Participation: its impact on services and the people who use them
IRISS 31 January 2019

• This review identifies the evidence behind using participation approaches and its impart on health or economic outcomes where participation is an umbrella term for any activity where the general public are involved in developing health and social care services. 
• Generally, it appears that co-production methods such as peer support, volunteering and co-delivery of services were beneficial, particularly for more efficient use of services and cost savings. 

Key points

Primary Care Co-Commissioning: Uptake, Development, and Impacts.

Understanding Primary Care Co-Commissioning: Uptake, Development, and Impacts.
PRUComm, 21 March 2018

• This research looks at the experiences of CCGs as they took on delegated responsibility for primary care commissioning based on case studies of four CCGs. 
• The study suggests that CCGs have taken to primary care co-commissioning with varying degrees of enthusiasm, but with a clear sense that the commissioning of primary care services requires local knowledge and involvement of trusted managers with expertise in primary care. The study discusses implications for policy and for management of primary care co-commissioning.

Understanding primary care co-commissioning

Understanding primary care co-commissioning:Uptake, scope of activity and process of change: Interim report
Policy Research Unit in Commissioning and the Health Care System (PRUComm), 20 April 2016

• This report aims to explore the uptake of primary care co-commissioning nationally, develop an understanding of the rationale underlying the policy and the expected outcomes, and understand the scope of co-commissioning activity and the process of change.

Primary care co-commissioning - survey of GPs

Primary care co-commissioning: a survey of members’ views of their CCG and its role in primary care
Kings Fund, Nuffield Trust April 2015

• Results of an online survey of GPs and practice managers in six CCGs. 

Changes to PMS Contracts

Changes to Primary Medical Services Contracts
Mills & Reeves 1 April 2015

• A summary of the changes and terms introduced by the National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) Regulations 2015 on 1 April 2015. 

Primary care co-commissioning CCGs

CCGs approved for joint commissioning of GP services
NHS England 5 March 2015

• From 1 April new primary care co-commissioning arrangements will start in 150 CCGs.

Risks to CCGs in the transition to co-commissioning

Risk or reward? The changing role of CCGs in general practice
Kings Fund, Nuffield Trust, 25 January 2015

• A report which considers how CCGs are functioning as membership organisations and how they are supporting the development of primary care in their local area has concluded that CCGs risk becoming unsustainable without changes to the way they attract leaders and adequate funding to help them expand their remit.
• The research included a survey, interviews, observations and reviews of CCG board papers.
• The report authors found that:
• CCG leaders questioned whether they had sufficient capacity to expand into primary care commissioning. 
• While the majority of CCG leaders felt that conflicts of interest were being managed adequately, researchers highlighted examples of decisions where there was the potential for conflict. 
• Few GPs felt that managing GP performance – something that contract management responsibilities under co-commissioning may lead to – was an appropriate role for CCGs. 
• The study outlines a number of key recommendations to CCG leaders and NHS England to assist CCGs in making the transition to co-commissioning and ensure the sustainability of CCGs.

What is co-commissioning?

Quick guide to co-commissioning
BMA Commissioning Guide

• What is co-commissioning, how does it work, GCP guidance and milestones.
• Includes links to key documents.

Primary care co-commissioning roadshow presentations

Primary care co-commissioning roadshow presentations
NHS England December 2014

• Presentations given at regional roadshows held throughout November and December 2014 give more detailed information to CCGs and area teams about the implementation of co-commissioning arrangements. 
• Including the benefits, vision, and key policy implications.

Managing conflicts of interest - guidance for CCGs

Managing conflicts of interest: statutory guidance for CCGs
NHS England 18 December 2014

• This statutory guidance sets out how CCGs should manage conflicts of interest. 
• It contains specific provisions in relation to co-commissioning primary care services but the guidance is relevant to CCG responsibilites generally.
• Update of March 2013 guidance

Primary Care Co-Commissioning Update

Primary Care CoCommissioning Update
NHS England 18 December 2014

• This update provides
• an update on the regional roadshows and a link to the presentations;
• a new set of questions and answers on co-commissioning, following the roadshow events;
• information on forthcoming webinars;
• key messages from the Primary Care Co-commissioning Programme Oversight Group;
• details about CCG constitution amendments;
• the final submission proforma for delegated co-commissioning arrangements;
• a summary of the contents and purpose of the delegation agreement to be published in January 2015

CCG allocations for 2015/16

Allocation of CCG resources 2015/16
NHS England 19 December 2014

• Including:
• CCG allocations for 2015/16
• the primary care allocation for 2015/16
• notional  split to CCG level to support the primary care co-commissioning agenda
• indicative specialised commissioning budget by CCG for 2015/16

Risks and opportunities of co-commissioning primary care

The risks and opportunities for CCGs when co‐commissioning primary care: Things to consider when making your decision
NHS Clinical Commissioners, RCGP 1 December 2014

• This paper  outlines the issues posed for CCGs by each of the three models of  co-commissioning of primary care proposed by NHS England, and outlines what NHSCC and RCGP consider the potential risks and opportunities.

Primary care co-commissioning

Next steps towards primary care co-commissioning
NHS England, 10 November 2014

• “Co-commissioning is a key enabler in developing seamless, integrated out of hospital services based around the diverse needs of local populations.”
• This document sets out the functions, governance arrangements and opportunities, potential benefits and risks of each co-commissioning model.
• The three proposed primary care co-commissioning models for CCGs are: 
• Greater involvement in primary care decision making – “an invitation to CCGs to collaborate more closely with their area teams”. No new governance arrangements required. 
• Joint commissioning arrangements – enables one or more CCGs to assume responsibility for jointly commissioning primary care medical services. There will be the option to pool funding for investment. CCGs could either form a joint committee or “committees in common” with the area team to jointly commission primary care services.
• Delegated commissioning arrangements - an opportunity for CCGs to assume full responsibility for commissioning general practice services using a standardised model of delegation.

Commissioning intentions for prescribed specialised services

Commissioning Intentions 2015/16 for Prescribed Specialised Services
NHS England, 3 October 2014

• This document serves as notice to all providers of specialised services in England of changes and priorities for the coming year for the specialised services to be commissioned by NHS England. 
• Commissioning responsibility for the following services will move to CCGs as from April 2015:
• specialised wheelchair services
• outpatient neurology referrals made by GPs to Adult Neurosciences Centres
• outpatient neurology referrals made by GPs to Adult Neurology Centres 
• It has been recommended that responsibility for commissioning these services will be moved to CCGs by April 2015
• renal dialysis (excluding encapsulating sclerosing peritonitis surgery)
• surgery for morbid obesity
• The following services will no longer be commissioned by CCGs from April 2015:
• some highly specialised adult male urological procedures
• some adult oesophageal procedures
• services for patients with homozygous familial hypercholesterolaemia
• some adult specialist haematology services
• Adoption of the information rules (IR) toolkit will be mandatory in 2015/16 and will require liaison between providers, NHS England and CCGs to jointly manage the alignment of contracts, activity flows and commissioning budgets.
• NHS England will be establishing arrangements to co-commission the majority of specialised services in partnership with CCGs
• Clinical thresholds and unwarranted variation in access to care - A programme will be developed to review differences in population intervention rates relative to need, involving provider clinical teams, NHS England and CCG commissioners, supported by Public Health England, to understand and resolve the addressable causes of outlying practice. 
• Clinical utilisation review (CUR) - NHS England has introduced a CQUIN to support providers in adopting the technology for specialised admitted patient care and critical care in 2014/15. The CUR CQUIN scheme is being made for use by CCG commissioners where it fits with local priorities such as underpinning changes to meet the goals of the Better Care Fund and improved Urgent & Emergency care.

Co-commissioning option announced

Local health professionals to get more power to improve NHS primary care
NHS England 1 May 2014

• Simon Stevens announced new option for local CCGs to co-commission primary care in partnership with NHS England at the Annual Conference of NHS Clinical Commissioners in London.