Professor Paul Corrigan considers how new models of care are reworking the future of commissioning.
This time last year, more than 90 teams of local leaders came to London’s Oval cricket ground – they were bidding to become new models of care vanguards. Each of the teams of leaders was differently configured, but nearly all of them included representatives from the leadership of their local clinical commissioning group (CCG).
While commissioners were involved in nearly every vanguard, none of these new models of care were at that time actually being commissioned; no one had written a spec which had then been followed up by providers.
And while over the last year many of the vanguards have developed with the strong involvement of CCGs, they are involved as local active change agents – not as commissioners.
I draw three important points from this:
Firstly, while CCGs do commission care, they are not only commissioning organisations. The best CCGs also know the needs of their local populations and have the knowledge and capability to act as powerful local change agents to meet those needs.
CCGs know what has been wrong with fragmented care and can play a full role in creating the new. For me, the lesson has been that if you absolve CCGs from developing population-based healthcare, you probably end up with a model heavily dominated by existing models of provision.
Secondly, in the development of almost any new product, it is the providers of services who have to carry out the ‘heavy lifting’ of change. It’s true that people who want to buy new services can draw up a new spec and demand that providers deliver to it. But unless the providers carry out the hard work of change, then however good the spec is, there won’t be a new product.
Over the last year this is how the new care models have been developing. Groups of providers – with the CCGs playing the active role of working through whole population needs – have been working to create the new from the very fragmented models of the old. Sometimes this involves six or seven different health and social care providers thinking through not just how they work together, but how they work completely differently with some provision – say from the voluntary sector – that just isn’t there yet. CCGs are in the room helping with the change.
Thirdly, most commissioners involved in the new care model vanguards recognise that at some point very soon these models will have to be commissioned. At the same time as developing new products with new outcomes, they know they need to develop the spec for that product in the future. They will also need a new commissioning vehicle for buying that new product.
In the present fragmented system, activity has been bought with fragmented contracts – if we want to buy new care models, we will need new forms of contract. And if we want health and social care services to work to better outcomes, we will need contracts that are based on outcomes and not on inputs.
The future of commissioning is being further reworked by the new care models. There is much practical discussion about the development of accountable care organisations (or partnerships). New governance models that bring existing fragmented providers together into one organisation are being worked through. Some of what happens currently in commissioning will have to form a part of this accountable care organisation.
To ensure that the public get a good deal, there will need to be a residual commissioning function left behind that will hold the accountable care organisation to a series of outputs and outcomes. At the end of this process, the new models of care will have created a new model of commissioning.
Professor Paul Corrigan CBE is working with NHS England to help develop new models of care. He is a non-executive director at the Care Quality Commission, adjunct professor of public health at the Chinese University of Hong Kong, and adjunct professor of health policy at Imperial College London. Follow him on Twitter @Paul_Corrigan
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