Co-commissioning of primary care services

Co-commissioning of primary care services

On 1st May 2014, NHS England Chief Executive Simon Stevens announced plans to allow Clinical Commissioning Groups (CCGs) to develop new models for co-commissioning primary care in order to “drive up the quality of care, cut health inequalities in primary care, and help put their local NHS on a sustainable path for the next five years and beyond.”

Stevens explained, “If we want to better integrate care outside hospitals, and properly resource primary, community and mental health services – at a time when overall funding is inevitably constrained – we need to make it easier for patients, local communities and local clinicians to exercise more clout over how services are developed.” 

Aims

The purpose behind this initiative was to achieve greater integration of health and care services, in particular more cohesive systems for primary care. It is also envisaged that co-commissioning would:

  • Raise standards of quality by encouraging a more collaborative approach to designing, developing and managing local solutions;
  • Reduce unwarranted variations in quality by creating greater alignment between specialist, primary care and local authority services;
  • Enhance patient and public involvement in developing services by promoting new models of care and innovative forms of commissioning; and
  • Tackle health inequalities creating greater consistency between outcome measures used in primary care services and wider out-of-hospital services.

Expressions of interest

CCGs were invited to submit their expressions of interest to NHS England by 20th June 2014, indicating their preferred co-commissioning form; 196 expressions of interest were submitted.

From CCGs’ early expressions of interest, NHS England identified some of the possible benefits of co-commissioning:

  • Improved provision of out-of hospital services for the benefit of patients and local populations;
  • A more integrated healthcare system that is affordable, high quality and which better meets local needs;
  • More optimal decisions to be made about how primary care resources are deployed;
  • Greater consistency between outcome measures and incentives used in primary care services and wider out-of-hospital services; and
  • A more collaborative approach to designing local solutions for workforce,premises and IM&T challenges.

Through the analysis of the CCG expressions of interest, it became apparent that there were three main forms of co-commissioning CCGs would like to take forward:

  1. Greater CCG involvement in NHS England decision-making;
  2. Joint decision-making by NHS England and CCGs; and
  3. CCGs taking on delegated responsibilities from NHS England.

A joint CCG and NHS England group – the primary care co-commissioning programme oversight group – was set up to work in partnership to design and agree with CCG leaders the practical next steps towards co-commissioning.

For 2015/16, NHS England stated the scope of co-commissioning was general practice services. They recognised the interest of some CCGs in commissioning dental, community pharmacy and eye health services, but this was out of scope of joint and delegated commissioning arrangements in 2015/16; this has remained the position. 

'Next steps towards primary care co-commissioning'

On 10th November 2014, NHS England published Next steps towards primary care co-commissioning. The purpose of this document was to provide CCGs with information on the opportunities and parameters of each co-commissioning model to help them decide on the model they would like to adopt. It also provided guidance on implementation arrangements.

While community pharmacy was not included in the co-commissioning plans for 2015/16 the document highlighted that during 2015/16, NHS England would explore the possibility of co-commissioning of community pharmacy services. To PSNC’s knowledge, this work was not taken forward by NHS England.

On 18 February 2015, NHS England announced that it had approved the first set of CCGs (64) that would take on responsibility for commissioning the majority of GP services from April 2015. Subsequent to this, most CCGs have taken on responsibility for commissioning the majority of GP services.

NHS England webpage on co-commissioning



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