Tips
From Basildon and Brentwood CCG:
“Commissioners need to start with unpicking both their and their providers perception of existing contracts, service specifications, this should be done in collaboration with service providers of health and social care, for either neurology or specifically epilepsy services. It is also important to establish which services fall under specialised and which fall under local commissioning. It may also be worth investigating what services are provided via Continuing Healthcare for the identified patient groups, this may provide a key to gaps in services currently provided or duplication of provision.
A good starting point is to map the existing pathway, this not only identifies gaps but duplication. This can then be reviewed against specifications and contract expectations.
Involving patients and services users in the mapping exercise helps to reflect providers view against actual experience, it also helps to see what other providers are involved and engaged in delivery of the patients care. CCGs understanding of wider services is always evolving, and engaging with patients/users helps inform this.
Understanding of what service provision is the remit of the CCG vs. NHS England, is critical for commissioners to differentiate the Specialist with the Specialised, use the NHS England Prescribed Specialised Service Manual as a starting point, and engage with the local NHS England representatives or contacts to clarify where required.”
- Review current service (contract, spend, specification and performance)
- Understand current pathway and any gaps
- Work where possible with providers to reduce gaps through remodelling with current providers
- Link with current/existing patient groups to review any change ensuring it delivers against need
- Use network approach to review and develop pathways of care that include or are supported by prescribing guides
- Ensure pathways are embedded within contracts to allow for review and audit against them and monitor impact
Patient and Public Involvement
The ‘House of Care’ is one example of how a proactive, person-centred approach can be achieved. It is made up of four inter-dependent components (1):
Commissioning – driving quality improvement.
Engaged, informed individuals and carers – enabling individuals to be involved in all decisions about their care, to self- anage and truly say ‘No decision about me without me’.
Organisational and clinical processes – structured around the needs of patients and carers using the best evidence available.
Health and care professionals working in partnership – listening, supporting, and collaborating for continuity of care. Professionals starting with patients not services.
(1) Patients and information directorate, NHS England, 2013. ‘Transforming participation in health and care – the NHS belongs to us all’, available at http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf.
Epilepsy
Ten Questions to consider when commissioning Epilepsy care services
- Will the service be visible and accessible to people with epilepsy within my CCG?
- How many people would use the service?
- Where would the service fit within the referral pathway for people with epilepsy?
- Will the service make GPs’ lives easier?
- What are the skill levels of my staff?
- What training could my staff be given to improve their skill levels?
- What information technology and infrastructure would be required to support the service?
- How will patient outcomes be monitored and assessed?
- How might the service develop in response to these assessments?
- How will patients be discharged from the service?
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