Commissioning - Leading the process of radical change
So often the commissioning round starts with acute providers presenting a list of additional funding requirements for discussion. It is essential that the commissioning process is designed and led by the PCT and is focused upon the commissioning objectives to be achieved. The agenda is challenging and can only be achieved with radical change.
The key question when trying to effect change is why would others wish to change? The answer is because there is mutual benefit in the process. The job of the commissioner is to devise a strategy that incentivises change and continuous improvement in services.
Achieving radical change in health delivery systems
PCTs have 3 key levers to effect change in health care:
1. Change the model of contract
2. Extend the range and types of service provision
3. Incentivise new models of service delivery
Change the model of contract
It cannot be the case that existing models of commissioning, provision methods of service delivery are the right way to deliver radical change. The first step on the path to change is from Block Contracts to Cost and Volume contracts. However, further options exist to provide more sophisticated and more patient centered contracting arrangements:
Extend the range and types of service provision
Incentivise new models of service delivery
The issues around these levers are explored in The Providers' section. However they are both also closely interconnected with the new opportunities provided by the development of
- enhanced services in primary care under the new GMS Contract
- Practitioners with Special Interests
Resources
Case Study 3 Bradford South & West
Case Study 8 Thurrock PCT
Primary Care Contracting area of the NatPaCT website
Practitioners with Special Interests
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