Community-based Commissioning: PPI and the new way of doing business in the NHS

Presentation by Dr Brian Fisher, PPI Lead for the NHS Alliance 21st June 2006

Community-based Commissioning:

• What users want
• What NHSA recommends – process to PPI
• Payment by Results and Practice Based Commissioning
• PPI+PBC
• Community Development may be the key

What patients want the structure to look like (MORI)

• Representative
• But also local
• Independent
• Accessible
• a wider range of people to be involved
• Accountable
• Change needs to happen as a result of PPI
• Democratic process

What do the public want to influence? (MORI)

• The development of new services
• The improvement of existing services
• The monitoring of quality
• The minimising of waste

Start with processes not structures

Developing a continuous process that:

• Creates engagement without exhaustion for clinicians, the public and patients. Brief liaisons are OK,
• Is flexible, drawing in a range of people in different ways and in different places
• Challenges but can also cooperate with the establishment
• Obtains rich ideas and recommendations
• Gets changes made

Support the system to change

• HCC with clear developmental standards
• PPI takes up a large proportion of the points
• Democratic/accountable processes at all levels:
• PBC
• Practices
• Foundation style involvement at PCTs and practices

Suggestions from the floor, please: how do we get monolithic organisations to become responsive?

Payment by results

• Money follows the patient
• More patients, more money
• National tariff, so no ability to attract referrals through price
• The idea is to attract through:
• Quality, speed
• Better relationships with PBC groups

Payment by results

• If over tariff, the hospital will lose
• Gaming
• Less than 24h admissions
• 24-47h admissions
• Shut services if you can’t compete
• Alternative suppliers of care

PBC+PPI

• Involve local people in:
• PBC cluster priorities
• Improving pathways
• Spending savings
• Monitoring quality
• PPI services should support clinicians
• Not confrontational
• Facilitating patient panels and PPGs
• Helping practices respond to wider determinants of health
• Using existing PCT techniques and agencies such as PALS. Expert patients are key here.

A SURVEY OF PCTs (NHSA)

• 172 / 299 responses: already active practice based commissioning in their areas.
• 70% PCTs say that PPI can have a positive impact on PBC and that they have good mechanisms for engaging with local people.
• 71% of PCTs who already have active PBC say there is little or no public and patient involvement involved.

WHAT WE WANT IS: ENGAGEMENT WITHOUT EXHAUSTION

One approach which is beginning to work well:

Community Development is the key

• A process that mobilises communities to become participants in both defining problems and developing solutions to health and health service issues, and that reaches out to those most likely to be excluded.
• Works with individuals and communities
• It promotes health by bringing people together in social networks
• Outreach flexibility
• Its raison d’etre is to get local voices heard and to support change
• Interdisciplinary because it listens to what local people say – links regeneration and health
• Light on practices, public and patients

Funding diversity reflects integration

• Community development approaches are already adopted by ODPM and the Home Office (Together We Can). Health needs to learn from them.
• Fund the CD workers from these diverse sources, spreading the load and increasing integration.
• Health Trainers ? Graduate MH workers offer another route

2 MODELS OF PPI FOR PBC CURRENTLY BEING USED IN THE BOROUGH OF LEWISHAM

• 4 PBC Groups in Lewisham – LCDP linked with each one
• Exploring change in the delivery of Diabetic services
• Starting in the most culturally diverse part of the borough
• Have developed a range of questions to explore in focus groups and with individual patients
• Following consultation will set up self help groups
• Positive impact on visits to A & E by these patients

LCDP has created a new model for patient involvement:

A PATIENT PANEL

• Inclusive and can capture views of the patients most difficult to reach
• A panel is being developed for the whole of a PBC area
• Very simple method of obtaining a lot of PPI quickly and cheaply

last updated 23/06/06