A Lay Persons Guide to Buying Healthcare
The Government's recent reforms of the NHS in England have changed many things. These changes are intended to improve the quality of care provided by the NHS and ‘to offer doctors and nurses the opportunity to play a major role in improving local health and wellbeing’.
One of those changes is that healthcare will be bought or ‘commissioned’ for all those who live in England by new organisations called Clinical Commissioning Groups (CCGs).
All GP practices in England must belong to a CCG. There will be 212 CCGs in England.
The CCGs will buy:
Elective (planned) Hospital Care (outpatients and inpatients),
Urgent and Emergency Services (A & E),
Community care and rehabilitation services,
Mental Health Services,
Learning Disability Services,
The Government provides a certain amount of money that the CCG will use to buy our healthcare. The CCG will decide how that money is spent.
The CCG will decide how much of each service to buy and where it will buy it from. So it has to choose which hospitals will provide our health care. They will be required to use any provider who is qualified to provide health services. This could be from NHS hospitals or it could be from private companies.
Commissioning is more than just simply buying healthcare. It is also about discovering what are the needs of the population, identifying the services required to meet those needs, deciding how services should be provided (pathways) and setting quality standards.
The CCG will then agree a contract with the service provider on an annual basis (April to March). Some contracts, especially those with private providers, will last for longer than a year, perhaps up to 5 years. Negotiations on contracts will usually start in the summer and are expected to be signed by the end of March in each year.
The price for each outpatient appointment and each treatment & operation is set by central Government.
Having bought the care the CCG will need to make sure that it gets what it paid for, both in the amount of care (the number of outpatients and inpatients, the number of tests etc.) and also the quality of care that is provided for patients.
The CCG also has to make sure that the quality of care improves each year.
The Government expects that each year the CCG must break even financially.
Some services will be commissioned by a national organisation called the NHS Commissioning Board. These include GP services, Pharmacies, Dentists and specialist services.
CCGs will be run by a board which has GPs as members, as well as a nurse and a hospital consultant. There are also two lay representatives and a number of other board members who will look after the finances and other activities.
Most of the managing of the contracts and the administration will be carried out by another organisation called the Commissioning Support Unit/Service.
The CCG will be held to account by its member practices and also by the National Commissioning Board.
The CCG is required to involve patients and the public in decisions about how it commissions our healthcare. I assume that it will do so through the Patient participation Groups but also through public meetings, surveys. The CCG may also involve patients through service users groups and voluntary organisations. One of the roles of the lay representatives on the board is to act as champions for patient and public involvement (Health and Social Care Act 2012 Section 14u).So if you want to influence how health care is delivered in your area I suggest you join your Practice Participation Group.