Commissioning challenges: relationships between public health specialists and clinical

commissioners

Dr Chris Packham RCGP National Commissioning Champion

GP and DPH

What commissioning? • CCG authorisation

– Clinical focus – Patient engagement – Credible plan – Governance – Collaborative

commissioning – Leadership

• Equity and Excellence – Redesign clinical

pathways – Partnership with

hospital specialists – Responsibility for

financial decisions – LTC management – Strip out….activities

that do not benefit health

QIPP and the DH expectations • The NHS QIPP challenge: ‘David Nicholson’s 20 billion’

• improving quality: more effective services, increased productivity

and efficiency • Elements of cost reduction to fund

– Quality – Innovation – Prevention

• The scale of challenge requires transformation • NHS inflation around 4-5% (1-2% demographics 3% technology

costs)

NHS spend 1979-2010

some commissioning tasks • Do Health Needs Assessments* (and EIA*s and

HEA*s and HIAs*) • Agree the facts with the public, politicians and

stakeholders* • Design and model your plans* • Decide what to prioritise* • Communicate • Procure • Monitor* • Evaluate*

* Require specific public health science skills

Some more commissioning tasks • How do we get a whole system approach

– Social care spending to save hospital bed blocking

– Housing spend to save mental illness admissions

• Balancing what is best (NICE guidance) with what is affordable

• Rationing

• Using evidence – Heart failure (cost saving)

– Total Parenteral Nutrition complications 44% to 9%

– For every 1% fall in smoking rates in persons with established vascular disease reduces subsequent NHS utilisation by 2% over a 3 year time frame

QIPP dilemmas: local example – Health checks

• 40-74 CVD healthchecks.

• 78,000 required to find 8,000 with a CVD risk >20%

• Locally adopted a highly targeted approach

• Found 80% of the high risk group by seeing 13,000

• Estimate see 21,000 to get 93%

• SHA demand – see 78,000!

Geo-demographic profiling: Mapping smoking cessation activity by area

Example

Superimpose high need groups

spot the gaps

Example

Public health and clinical commissioning

• (good) GPs bring – Clinical reality – Safe, efficient re-

design – Patient-friendly plans – Problem-solving with

hospitals – ‘credible’ rationing

• (good) Public Health brings – Technical analysis – Population perspective – Material to allow GPs

to make decisions – Rational basis for

unpopular decisions – Wider determinants

actions – Social care link