01.10.15
CCGS: Early challenges but primary care co-commissioning progressing well
Source: NHE Sep/Oct 15
Stefanie Rutherford, senior co-commissioning manager at NHS England, discusses the early challenges and opportunities identified by CCGs on primary care commissioning.
Reflecting on the first six months since taking on primary care co-commissioning duties, CCGs have reported challenges in finding the money and staff time to take on the work, as well as difficulties in setting up governance arrangements and data sharing. But, overall, work is progressing well.
Speaking at NHS Expo, Stefanie Rutherford, senior co-commissioning manager at NHS England, revealed the early feedback after analysing the first 57 responses to the organisation’s primary care co-commissioning survey.
Addressing an audience that turned out to be made up mostly of providers rather than commissioners, Rutherford said: “As with any initial scheme of this scale – and we have come a long way in quite a short period of time – there is inevitably going to be some early challenges and teething issues that we need to work through.
“But, on the whole, clinical leadership in primary care has been strengthened.”
Finding the funds
Back in November 2014, NHS England revealed that CCGs would not receive any extra funding to take on primary care co-commissioning. It is hardly unsurprising that, given this, one of the early challenges centred around “capacity and identifying resources to take on the work”.
Rutherford said: “CCGs haven’t had any additional resources to deliver primary care commissioning. And at the same time our local NHS England teams are now supporting multiple co-commissioning models, so they are supporting a number of delegated CCGs to take forward their new responsibilities and they are supporting a number of joint commissioning committees in their patch.”
NHS England knows there is a need for more spending on primary care commissioning. The Five Year Forward View makes clear that it is the aspect of the health service that will see the “greatest level of change” over the next five years
The audience was told “with regards to resources we are working a lot with national partners to ensure that commissioning arrangements are sustainable for the long term”. However, this was not expanded upon.
Governance
Since April, just over 70% of co-commissioning CCGs have taken on either joint or delegated arrangements across England.
CCGs also noted that there had been challenges around governance arrangements. In particular, Rutherford mentioned that there had been issues in setting up the new Primary Care Commissioning Committees – a requirement of delegated commissioning arrangements.
“Early challenges were around agreeing membership with the committees and agenda-setting. But I think these have largely been worked through, now we are six months in.”
Data-sharing has improved, Rutherford said, though there is still work to do.
QOF and DES
Discussing, briefly, what measures NHS England is taking nationally she said that guidance would be published soon for commissioners on developing alternative schemes to the Quality and Outcomes Framework (QOF) and existing Directed Enhanced Services (DES).
With regards to conflicts of interest, she said: “We are doing a sample audit of 10 primary care co-commissioning arrangements in September, with an aim of identifying and sharing good practice in support of development, which we will be sharing the findings of later this year.
“Finally, there is a lot of ongoing work to strengthen information flows and data sharing. We are working very closely with HSCIC.”
She added that design work has also commenced to look at how complaints can be best managed under the new co-commissioning arrangements.
During the presentation Rutherford also noted that CCGs have identified a number of improvements since taking on either joint or delegated commissioning arrangements.
These have centred around four key themes: helping to deliver an aligned vision and strategy for primary care; CCGs reporting increased enthusiasm for taking forward new models of care; strengthening relationships with a number of stakeholders, in particular member practices; and strengthening public involvement.
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