Commissioning for a better future: A starter for ten

Commissioning for a better future: A starter for ten

Social Care Innovation Network June 2020

• A framework for commissioning for the future that sets out how commissioning can practically support the development of asset-based areas. Sets out good practice examples and alternative approaches to commissioning care and support across England. Provides examples (with links) of how better outcomes have been achieved through alternative and positive approaches to commissioning.

Thinking differently about commissioning: learning from new approaches to local planning

Thinking differently about commissioning: learning from new approaches to local planning
Kings Fund 6 February 2020

• Collaboration is promoted as a key tool for improving health services. Visits to CCGs (South Tyneside, Tameside and Glossop, Bradford district and Craven) suggest that collaborative planning arrangements at place level – on footprints that are often approximately co-terminous with local authorities – will be important in the future. 
• This report explores the implications of new ways of working for the development of integrated care systems, how NHS England and NHS Improvement’s regional teams operate, and wider ways of working among NHS national bodies.

GP partnership review: final report and business model case studies

GP partnership review: final report and business model case studies
DHSC 15 January 2019

• The review outlines the challenges and benefits of working in general practice and of the Partnership Model. These include workforce issues of recruitment, retention and education and training; workload, status and role of partnerships and primary care networks; and the emerging opportunities for primary care in terms of digital and technology.
• The review concludes that "the current model of care in the NHS is too dependent on hospital-based care. This model is not sustainable, and we cannot move forward without change that includes general practice and partnerships at its heart."
• A separate report presents case studies of different business models in general practice. 

GP Partnership Review: interim report

GP Partnership Review: interim report
DHSC 4 October 2018

• The interim report describes progress so far and outlines the challenges facing the GP partnership model. It identifies areas where the review will look for solutions to reinvigorate the partnership model and support the transformation of general practice.
• GP Partnership Review: mythbuster - Common questions and issues raised about partnerships. 
• See the analysis from Mills & Reeve here

What is Distinctive about an ABCD Process?

The Four Essential Elements of an Asset-Based Community Development Process.
ABCD Institute at DePaul University September 2018

• The primary goal of an Asset-Based Community Development (ABCD) process is to enhance collective citizen visioning and production through a process that combines four essential elements: 1. Resources 2. Methods 3. Functions 4. Evaluation. 
• This paper discusses each of these elements in detail in an effort to answer the following question: “what is distinctive about an Asset-Based Community Development process?” 

Advanced Primary Care: A Key Contributor to Successful ACOs

Advanced Primary Care: A Key Contributor to Successful ACOs
Patient Centred Primary Care Collaborative 1 August 2018

• A review of published evidence, expert opinions, and secondary data analysis suggests the interdependence of advanced primary care models (such as the patient-centered medical home) and Accountable Care Organisations (ACOs)in achieving improved population health, lower costs, and better patient experiences in health care.
• Thematic analysis of the final included studies revealed a number of key recurring characteristics that help ACOs enhance patient satisfaction, lower costs, and improve population health. These characteristics can be organized within six broad themes:
• 1. Leadership and Culture
• 2. Prior Experience
• 3. Health Information Technology
• 4. Care Management Strategies
• 5. Organizational and Environmental Factors
• 6. Incentive and Payer Alignment. 
• These characteristics of successful ACOs align closely with the attributes of the patient-centered medical home (PCMH) (Figure 1).

Innovative models of general practice

Innovative models of general practice
Kings Fund 7 June 2018

• This report looks at innovative models of general practice from the UK and other countries and identifies key design features which will be important in designing effective GP services in the future.
• The report sets out five attributes that underpin general practice: person-centred, holistic care; access; co-ordination; continuity and community focus.

The effects of integrated care: a systematic review of UK and international evidence

The effects of integrated care: a systematic review of UK and international evidence
BMC Health Services Research 2018 v18:350

• A systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care identified 167 published studies. 
• The evidence indicates that models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, but the evidence for other outcomes including service costs remains unclear.

A Royal Commission on the NHS: The Remit

A Royal Commission on the NHS: The Remit
Centre for Policy Studies 8 January 2018

• A briefing from the Centre for Policy Studies think tank proposing that a Royal Commission should examine the structure, funding and sustainability of the NHS in England as a whole.

Provider maturity model in primary care

Provider maturity model
Healthy London October 2017

• The provider maturity model is a development tool that was designed with primary care providers across London to support the development of at scale organisations.

Developing accountable care systems: lessons from Canterbury, New Zealand

Developing accountable care systems: lessons from Canterbury, New Zealand
Kings Fund, 24 August 2017

• Useful lessons for the NHS from the transformation of health care in Canterbury, New Zealand over the past 10 years. These changes were achieved through developing a number of new delivery models, which involve better integration of care across organisational and service boundaries, increased investment in community-based services, and strengthening primary care.
• Models implemented in Canterbury include:
• HealthPathways – primary care management and referral pathways 
• the acute demand management system 
• the electronic shared care record view 

Asset based places: a model for development

Asset-based places: A model for development

SCIE July 2017

• An asset-based approach places the emphasis on people’s and communities’ assets, alongside their needs. This briefing suggests a framework for local areas to enable asset-based approaches to thrive.
• Includes case studies and further reading.

Learning from Scotland’s NHS

Learning from Scotland’s NHS
Nuffield Trust 5 July 2017

• This report looks at Scotland’s unique health care system, and explores how other parts of the UK might be able to learn from it.
• In articular Scotland has a longer history of drives towards making different parts of the health and social care system work together. It has used legislation to get these efforts underway, while recognising that ultimately local relationships are the deciding factor.

The effects of environmental factors on the efficiency of CCGs

The Effects of Environmental Factors on the Efficiency of Clinical Commissioning Groups in England: A Data Envelopment Analysis
Journal of Medical Systems 2017, 41:97

• The performance of CCGs may also be confounded by environmental factors such as deprivation, population size and burden of disease. This study estimates the technical efficiency of 208 CCGs in England using Data Envelopment Analysis (DEA), a linear programming technique that can be used to measure the relative efficiency of a given set of organisations. 
• The inputs and outputs used include budget allocation, number of general practitioners, mortality rates, patient satisfaction and QOF scores. 
• Three environmental factors were statistically significant predictors of efficiency: CCGs with smaller population sizes were more efficient than those with larger ones, while high unemployment rates and a high prevalence of chronic obstructive pulmonary disease led to a decrease in efficiency scores. 
• Comparative deprivation was not a significant predictor of efficiency.

Whole Population Management

Whole Population Management: Opportunities and how to realise them
Conrane IHS 7 April 2017

• This briefing examines how Whole Population Management can progress the objectives of STPs using an Accountable Care Organisation model. 
• Central to the model is use of a risk stratification prediction model, such as ACG, to support patient identification and enrollment.
• The report outlines core workforce roles with indicative job contents, decision support tools used,  and how the model could work at a locality level within the NHS using a hub and spoke model (30-50k population)

Practicalities and evidence base behind care intgration

Integrated care: A pill for all ills?
International Journal of Health Policy and Management 2017;6(1):1-3

• The authors discuss the practicalities of care integration, both within the healthcare sector and between the health and social care sectors, including the mechanisms by which it is expected to achieve its aim and the evidence base around the outcomes delivered.
• The authors conclude:
• Key elements of the process, such as the degree of financial integration and the alignment of vision and cultures across professional boundaries, will influence the capacity of integrated care to deliver its potential. ... the evidence base is not definitive and there are many gaps in knowledge about the degree to which most of the expected benefits from integrated care will materialise: “integrated organizational structures and processes may fail to produce integrated patient care.”

Realising the Value - delivering community centred health and wellbeing

Realising the Value    (www.realisingthevalue.org)

Health Foundation, Nesta 15 November 2016
This programme examined the evidence on what good person and community-centred care looks like and the potentially wide-reaching benefits then developed and tested ways to embed these approaches, creating a set of tools to allow these to have national and local impact.

Primary Care today and tomorrow: Adapting to survive

Primary Care today and tomorrow: Adapting to survive
Deloitte Centre for Health Solutions, November 2016

• Research suggests a number of measures could help commissioners and providers and help deliver a more sustainable system of primary care for tomorrow:
• collecting robust, comprehensive and timely activity and performance data across primary care on both supply and demand is a critical requirement if the full potential of new care models is to be realised 
• securing adequate levels of funding for general practice of  over ten per cent of the healthcare budget (as prioritised in the General Practice Forward View) and investing more in prevention, wider primary and social care
• prioritising innovative and proactive workforce strategies that include effective workforce planning, recruitment and retention strategies for GPs, practice nurses and the wider primary and social care workforce
• shifting from medicalised models of care towards sharing out responsibilities and risks across permeable professional boundaries among the wider primary care team
• aligning incentives through integrated funding and commissioning
• improving health literacy to help patients take more responsibility for their own health and enhance patient participation and engagement in healthcare planning and delivery
• improving, as a matter of urgency, the primary care estate and  extending the adoption of digital health technology through effective partnerships.

New care models Emerging innovations in governance and organisational forms

New care models: Emerging innovations in governance and organisational forms
Kings Fund 11 October 2016

• This report looks at the different approaches being taken by MCP and PACS vanguards to contracting, governance and other organisational infrastructure. It focuses on developments at:
• Dudley; 
• Sandwell and West Birmingham (Modality Partnership); 
• Salford; 
• Northumberland; and 
• South Somerset (Symphony Project)
• "The vanguards have shown just how important it is to build collaborative relationships between the organisations and leaders involved in developing new care models. Delivering results will take time, but there needs to be a focus on the relational elements of new care models as well as the technical elements."

Is Bigger Better? Lessons for large scale general practice

Is Bigger Better? Lessons for large scale general practice
Nuffield Trust 19 July 2016

• According to  research drawn from a 15-month study of large-scale general practice organisations in England, three quarters of English practices have now joined large-scale GP organisations, formed to help cope with rising pressure and policies demanding longer hours and new services. This report discusses the factors influencing collaboration in general practice.
•  While these organisations can help to sustain general practice in the face of intense financial pressure and shortages of doctors and nurses, they have so far made limited progress in expanding into new services, and taking on a strategic role in redesigning care.
• Key findings are as follows:
• This agenda is well underway across the country, with almost three-quarters of general practices already in some form of collaboration with others, almost half of which formed during 2014/15. The major reasons for forming were to ‘achieve efficiencies’ and ‘offer extended services in primary care’. 
• Larger scale has the potential to sustain general practice through operational efficiency and standardised processes, maximising income, strengthening the workforce and deploying technology. 
• However, scaling up will take a lot of hard work and cannot just be left to a few heroic leaders. All GPs will need to play a part in making these new organisations successful.
• The evidence that these organisations can improve quality is mixed. Patients had differing views about the benefits of large-scale organisations. Some appreciated increased access, while others were concerned about losing the close relationship with their trusted GP.
• The case study organisations had established high-quality specialist services in the community which were popular with patients, but were delivered at relatively small scale. Trust and close engagement between practitioners and commissioners were very important for successful implementation. CCGs had to manage the tension between supporting large-scale organisations to develop while also managing conflicts of interest.
• The report offers a series of practical insights and lessons for general practitioners as well as important lessons for policy-makers, national leaders and commissioners.