COOPERATIVE

COMMISSIONING
IN LEWISHAM
Dr Brian Fisher MBE
Clinical Advisor
Lewisham CCG
Commissioners we have a problem


Payment by Results has lost its

PAYMENT BY RESULTS
An incentive for
increasing turnover
and efficiency
PAYMENT BY RESULTS
A way of running a system
that offers conflicting incentives
and impedes integration
Hospitals have little incentive
to move services
into the community.
YEAR OF CARE MODEL
risk adjusted capitation budget
unbiased estimate of the expected costs of
the citizen to the health care plan over the
chosen time period typically one year
1y, 2y, social care collaborate
population stratified
Integrated care in the community
INFORMATION NEEDED
Local data will be needed to understand the current situation including:
Risk profiling (RP) data
LTC registers in primary care
LTC prevalence and expected prevalence
QOF scores
LTC Prescribing
Acute admissions relating to LTC (and bed days)
&E attendances relating to LTC
Ambulance activity and costs
Long term care activity and costs (social care)
People with LTC & carer confidence in the care/services delivered
Individuals confidence in the ability to self care
Use of total resources (budget vs. spend on LTC care in primary, community, secondary, and
social care,
ambulance and third and independent sector)
Total resources available for an integrated LTC service (all LTC related: community services,
secondary care A&E
attendances & acute admissions, free social care services, third and independent sector
services)
COOPERATIVE
COMMISSIONING

Programme Budgeting: a retrospective
appraisal of resource allocation broken
down into programmes with a view to
influencing and tracking future expenditure
in those same programmes.

USE OF PBs
Showing where NHS funds have been
spent in a way that is useful to taxpayers
Enabling expenditure to be assessed
against outcomes
Providing consistent data for comparisons
Assisting CCGs in planning, effective
budgeting and commissioning

2Y CARE
A JOINT PROGRAMME BUDGET
IY CARE SC+H



2Y CARE
IY CARE
SC+H
SAVINGS ARE RE-INVESTED
Particularly handy as:
the Trust Is responsible for
community services
80% of our work goes to the Trust
INCENTIVISE COLLABORATION
MORE UPSTREAM WORK
KEEPS CONTROL IN THE CCG
COMMISSIONERS
JOINT MANAGEMENT BOARD
pathway providers
patients and patient groups
3rd sector
primary and community care
social care
acute care and social enterprises
nurse specialists, therapists,
social workers etc.
do not sit on the Board
do not do the redesign
hold the board and individual providers to
account for delivering outcomes
support and challenge to the board.
arbitrators in disputes about resource and
financial management.
JOINT MANAGEMENT BOARD
does the redesign work
responsible to commissioners for delivery
against defined outcomes
outcomes to include NICE patient
experience standards
contracts with each provider to
work within the Joint Management Board structure
where appropriate form part of the integrated team
THE PB FOR DIABETES
the community budget for diabetes
services
primary care extended provider services,
inpatient care
outpatients
social care spend for patients
on the population register
with social care needs.
PRIMARY CARE GIVES
neighbourhoods enter into a written agreement
with their provider colleagues committing to:
delivering elements of the pathway, working with
other pathway providers.
provide data to
ensure high quality care for the neighbourhood LTC registers,
ensure outcomes are demonstrated
enable budgetary management of the pathway by the JMB.
follow clinical practice
defined by jointly developed
protocols of JMB.
PRIMARY CARE RECEIVES
opportunities to shape the nature of the redesign
payment for work in the pathway as determined
by outcomes achieved.
support from the other members of the
integrated team in terms of managing patients,
training and development support.
support from other neighbourhood practices
such as
peer review,
effective resource use,
training and development.

COOPERATIVE
COMMISSIONING
ANY QUESTIONS?