Commissioning:

A New Beginning

HIV Prevention England

20th February 2014

For discussion

• New beginning – is it?

• The new architecture - what do we need to know?

• Opportunities and challenges

• Commissioning goal – common ground

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New beginning or next chapter? • New organisations: HWBB, Clinical Senates

• New responsibilities: duty to promote integrated health, social care and ‘health related services’ around the needs of service users

• New cultures, new ways of working

And

• Some things remain the same

• Continued focus on reducing sexual ill health and promoting good health

• Increasing need for improved quality and reduced cost

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The architecture

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The architecture • Local authorities – responsible for prevention services for

local populations

• NHS England – responsible for commissioning primary care (including dental etc.), health in the justice system, military health, screening programmes

• NHS England – responsible for commissioning prescribed specialised service through provider based commissioning for all eligible England patients

• Clinical commissioning groups (CCGs) – supported by commissioning support units - responsible commissioning community and acute care for local populations

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At the interface?

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LAs NHS England

People: SH commissioners TUPE into LAs

People: Specialised commissioners with broad portfolios

Focus: Local Population

Focus: Providers

Provider landscape approach: Market testing and tendering?

Provider landscape approach:Service specification compliance & reconfigurations

Organisational approach:Local prioritisation and decision making

Organisational approach:Single operating model and equity for all England patients

Challenges and Opportunities• Relationships

• Flexibilities

• Responsibilities

• Governance

• Cultures

• Innovation and change

• Targets

• The money

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Common ground

•Reduce ill health and improve good health

•Improve outcomes and experience for people and populations

•Service redesign solutions

•Ensure safe and appropriate services available

•Deliver roles and legal responsibilities

•Deliver savings and value for money

•Duties around partnership and integration

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Shared agendas • Reducing new infections (and arrangements for

PEPSE , consideration of TasP and PrEP)

• Expanding testing and earlier diagnosis

• Quality standards

• Clinically appropriate care

• Innovation and new models of care

• Cost efficient care

• Personal responsibility and self management

• Service user experience and co-production

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Making the new arrangements work

The allegory of the long spoons…

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