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5.8 Promoting IP: to commissioners

Commissioning is one of the main mechanisms used at the local level to fund and plan local health systems. Commissioners will be interested in the part IPs can play in helping people with long-term conditions undertake more self management.

Understanding how people are using services and what they need is all part of the IP process and will commissioners to develop better links with communities to inform local decision making and priority setting. Also, by communicating service expectations through the IP, commissioners are more likely to find out from users and carers where and when things go wrong.

Listed below are the Department of Health's 'world class commissioning competencies' for PCTs. The competencies 1 to 11 (apart from 9 and 10 that do not apply) have been listed below along with opportunities for action:

• 1. Locally lead the NHS
  PCTs, using their skills as leaders of local health services, are expected to encourage local stakeholders to work together so that information resources can be pooled to the benefit of users and carers. This will ensure a whole systems approach across health and social care.
• 2. Work with community partners
  PCTs can ensure that local IP partnership arrangements actively influence commissioning decisions by ensuring partners (local authority, NHS providers, voluntary sector, patient groups) are involved in each stage of the commissioning cycle – supplying information on user needs, identifying resources and setting priorities, planning patterns of services, and commissioning and monitoring and review. Local partnership arrangements and joint commissioning arrangements should be utilised to provide strategic direction, planning and commissioning for local IP delivery:
• 3. Engage with public and patients
  PCTs are required to liaise with local communities. Encouraging user and carer dialogue through the IP programme of development is essential and will gain useful insights for commissioners on how local pathways are perceived. Commissioners need to take action to address the gaps in patient pathways as part of continuous improvement of services. explore ways to target more disadvantaged groups through commissioning strategies so that those facing disadvantage are given additional support to meet their needs.
• 4. Collaborate with clinicians
  Clinical engagement is key to informed commissioning. IP provides a perfect opportunity to review patient pathways and look at how information can provide better care, more opportunities for self care and knowledge of wider community support. NHS organisations will want the buy in from clinicians to enable the development and delivery of IP. Pilots found that implementing IPs went better, quicker and faster when clinicians were involved.
• 5. Manage knowledge and assess needs
  Personalising IPs is predicated on having a good understanding of the needs and preferences of local people, such as what information they want, how they want it, and where they want it. Some pilots conducted user surveys to make better assessments about the local population, while other ran focus groups. Both processes should be part of the local strategy for identifying local needs. However, in future, other more quantitative data sets, which combine local intelligence about the population will need to be drawn into local implementation strategies, and help inform commissioning priorities. PCTs can also look at the current pattern of information provision and outcomes in their area, and recent trends, against national and relevant local comparators. What survey evidence or inspection data (such as the HCC patient survey) is there about the quality of information, gaps in information, and needs for information. How does the area compare to other localities on information provision. What are the existing examples of good practice, such as information giving in well developed in local cancer networks Look within the overall picture at outcomes for particular groups of local people, stratifying the population by the major determinants of health inequality, such as age, gender, and socio economic backgrounds. Use all this data, and draw on the views of local users and carers, clinicians and frontline staff, to develop an overall, integrated strategic needs assessment for IPs.
• 6. Prioritise investment
  Agree on the nature and scale of the local challenge, identify the resources available and set priorities for action. Ask questions such as, what model of IP deliver will reach the largest numbers of local people? What models will reach those most disadvantaged. Plan the pattern of service most likely to secure priority outcomes, considering carefully the ways in which resources can be increasingly focussed on self management and less intensive interventions where they are not necessary. Decide together how best to purchase or provide (commission) those services, including drawing in alternative providers to widen options and increase efficiency. Include the voluntary and community sectors, LINks and the private sector in these discussions.
• 7. Stimulate the market
  Linking IP development to NHS Choices so that users and carers have the whole picture of how they can self manage their condition and have choices of hospital or community services when they need them.
• 8. Promote improvement and innovation
  Monitor and review to ensure services are working to deliver the ambitions set out for them.Develop a better knowledge and awareness amongst local commissioners in IPs and how they can help local services achieve wider service improvement objectives. Plan for the workforce development and other changes in local processes and ways of working necessary to support delivery.
• 9. Secure procurement skills.
• 10. Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvements in quality and outcomes.
• 11. Make sound financial investments
  Develop and extend joint commissioning from pooled budgets and pooled resources to support the IP programme.

This brings us to the end of the 'promoting IP' section. On the next page we start a section on training and support for IP