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Commissioning

Commissioning. Iain Marley Commissioning Officer – Children Commissioning Systems Development – South South Tees Clinical Commissioning Group. ….and today, I’m…. The “Acceptable Face” of NHS Tees. Context – the overall picture. 42 major contracts across NHS Tees

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Commissioning

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  1. Commissioning Iain Marley Commissioning Officer – Children Commissioning Systems Development – South South Tees Clinical Commissioning Group

  2. ….and today, I’m….The “Acceptable Face” of NHS Tees

  3. Context – the overall picture • 42 major contracts across NHS Tees • Majority are nationally mandated standard contracts: • NHS Standard Acute Contract - NTHFT, STHFT, Nuffield, Ramsay etc • NHS Standard Community Contract - North Tees Community Provider, MRCCS, Assura Sexual Health, Hospices etc • NHS Standard Mental Health Contract - TEWV, Alliance, MIND etc. • Total Contract Budget of £856m • Over 200 providers • QIPP Challenge

  4. QIPP Challenge: 2012/2013

  5. Contract Negotiation Constraints • 12/13 Affordability versus Forecast Outturn activity/cost • SHA/DH expectations • Operating Framework requirements must be negotiated in to contracts • Deadlines for contract signature • FAILURE TO AGREE WITH PROVIDERS WILL RESULT IN NOT HAVING A SIGNED CONTRACT AND CCGS AFFECTED WON’T ACHIEVE AUTHORISATION • Clinicians views are not necessarily the organisation’s views • Payment by Results (PBR) • It is in the Foundation Trusts (FTs) interests to grow their business • Commissioners are immediately on the back foot once a patient enters “the system” – “Patient Pinball” • FTs will exploit Primary Care’s inability to manage demand • “It is what it is” – a negotiation: we don’t get everything we want!

  6. Contract Negotiation Constraints • Delayed publication of Operating Framework and Standard National Contracts • Lack of evidence based, clinically credible proposals resisted as unsafe/high risk to FTs • New services/changes to pathways – “Pilot Vs. Procurement” • Overall impact of Commissioning Intentions: • Don’t do anything which may increase overall costs • Consider system wide impacts on other stakeholders, e.g. Social Care

  7. Timetable

  8. Meanwhile, back in the land of Clinical Commissioning… • NHS Hartlepool and Stockton on Tees Clinical Commissioning Group • Hartlepool CCG • Stockton-On-Tees CCG • South Tees Clinical Commissioning Group • Middlesbrough CCG • Redcar and Cleveland CCG • Greater Eston CCG

  9. Clinical Commissioning Agenda • Still in process of formation • Structures • Leadership • Priorities • Heavy Authorisation Process • Wide Agenda • CAMHS IS part of it – we do have clinical engagement!

  10. CAMHS Priorities • Earlier intervention in CYPs Emotional Health and Well-being • Shifting resources upstream through 2 priorities: • CAMHS service transformation (TEWV CAMHS contract – changing the core service to deliver accessible, community based services) • Developing Tier 1 and 2 services • Co-ordinating commissioning across Tees • Developing/increasing the capacity of the broader delivery system – schools, VCOs

  11. Progress to date • Strategic CAMHS Stakeholder Group – meets monthly - LA rep, GPs, Head Teacher and VSO rep – increased commitment to CYP’s MH • Strategic Tees-wide Plan - response to NST review, needs assessment - mapping of ‘tier 2’ services • TEWV CAMHS Performance dashboard - using new Info management system in TEWV • Service transformation funding agreed…. • BOND– capacity building in early intervention MH third sector services

  12. Aims • Aim to drive down T3 referrals - increase earlier intervention, and increase capacity within other services through consultation, training and shared, co-ordinated pathways • Potential non-recurring - £0.5m • fund increased activity and development at tier 2 • embed workforce plan for sustaining new service model • manage risk/existing demand at tier 3/4 • £200k ring-fenced for third sector sub contracting – to extend good practice in pathway development and increase access for vulnerable groups

  13. Why now? • Funding window – speedy action required • NHS capacity to drive change through commissioning • Financial climate – mitigate impact of early intervention cuts • BOND – building interest and momentum • Schools – interest in funding services • Improving quality of VCS/alternative providers • Identifying and sharing models of good practice

  14. Next steps… • Strengthen LA/NHS commissioning • co-ordinating/joint commissioning for LAC, VSO etc • commissioning with/by schools for early intervention support in schools • Develop outcomes framework- for CYPs MH services Tier 1 – 3 – as a basis for commissioning • Develop core TEWV offer/spec • Commission training programme from CAMHS- for T1 and 2 service providers as part of service transformation

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