World class commissioning: this ridiculed plan might just be working

12 August 2010 | By Alastair McLellan

World class commissioning arrived too late and burdened with a name that virtually guaranteed ridicule. But, unfashionable though it may be to say, it is beginning to deliver results.

Primary care trust managers are to be congratulated. HSJ’s unique analysis shows the detail behind the second annual assessment of PCTs against the governance standards and organisational competencies encapsulated in the world class commissioning framework. The results are a cause for celebration. Significant improvements have been made since year one. If this process had begun a few years earlier, then the move to GP led commissioning might not be so easy for the new government to insist on.

We must not have a slump in commissioning standards while the new framework is put into place

Whatever the shortfalls of the WCC assurance scheme, and no such measurement regime is perfect or loved, there is much to be learned from analysing these results, as PCT Network director David Stout sets out. Significantly, he claims last month’s white paper’s talk of achieving “world class outcomes” is not a million miles away from the goals of WCC and that GP commissioning too will need some kind of, lighter-touch, assurance scheme.

This is a crucial point. Many PCTs have not traditionally or previously delivered good quality commissioning, for whatever reason, but some are now beginning to. We must not have a slump in commissioning standards while the new system is put into place.

The Department of Health has told HSJ there will not be WCC assurance for PCTs next year. This is a serious mistake - the NHS cannot afford to fly blind during this critical period of cost constraint.

Of course, it may prove politically convenient to pretend PCTs are not improving - or indeed that the WCC standards are not worth bothering with. But the truth is that the people of Hull, Salford and Tower Hamlets - to name the top three performers - are well served by their PCTs. In two years, if improvement continues, the best are likely to be very good indeed and even the “average” PCT would be delivering satisfactory results.

Of course, it is a very big “if”. PCTs might not have the skills to maintain this rate of improvement. It is much more likely that PCTs will be unable to drive improvement because they will be focusing on developing GP consortia to take over.

This should give local authorities, in their new watchdog role, pause for thought.

Will the people of Hull, Salford and Tower Hamlets be better served by a GP takeover? Would it not be preferable for greater GP involvement to be reversed into the existing structures? Would this not be a more reliable way to ensure the progress made was not lost and the learning, corporate memory and talent that underpinned it retained?

Retention of talent is vital. With the publication of HSJ’s analysis, Christopher Long, Mike Burrows and Alwen Williams - the chief executives of the top PCTs - along with their senior teams, will go straight to the top of headhunters’ wanted lists.

Whether it be a role in the national commissioning board, a directorship in a private sector commissioning company or a senior position with a business looking to deliver chronic disease management services into the new landscape, these people will be in demand. Some may stay to become accountable officers within consortia, but many will be more ambitious.

HSJ suggests the GPs of Hull, Salford and Tower Hamlets (together with those from the Tees area, the Wirrall and Hammersmith) quickly organise to make their PCT directors and senior managers an offer they can’t refuse.

Readers' comments (14)

Anonymous | 12-Aug-2010 9:10 am
Everyone needs to see the tools deployed by the top 10 that have delivered no overspends on the main hospital contracts, before "offers" are made - achieving ticks in boxes will not deliver efficiencies to cover the £20bn shortfall in healthcare - can HSJ get hold of such information from the top 10 and share?
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Anonymous | 12-Aug-2010 9:45 am
Tower Hamlets has spent over 9 million on management consultants in the past 2 years to get to rank 3 in the WCC league table. They got £23 million (5.1%) more parliamentary revenue funding than they should in 2009/10; they scored 2 (‘mediocre’) on effectiveness and efficiency of spend; and their health outcomes are appalling, according to the latest health profiles.

Just shows why GP consortia can’t give any offers to anyone without doing their own independent analysis. Relying on biased analysis, and input and process indicators, rather than outcomes to measure the effectiveness and efficiency of any organisation is flawed.

World Class Commissioning was one of the most ridiculous and biggest money wasting ideas NHS commissioning has ever had. If the people who invented it, or advised on it, end up running the NCB or advising the NCB, NHS commissioning will continue to fail.
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Anonymous | 12-Aug-2010 10:25 am
Yes WCC was flawed and yes it was a saddled with a title that invited ridicule. It was though the first serious attempt to define the role of the commissioner and set expectations for improvement. Such a change takes time - particularly the shift of care away from an acute setting. The focus on inputs was always intended to be a short transition to health outcomes. If commissioning survives the ninth reorganisation since the early 90's then many of the attributes and competencies required of the new GP commissioning groups will be found in WCC - although no one will admit this!.
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Anonymous | 12-Aug-2010 10:28 am
Having wasted several months of my life on WCC, I suspect that most of the improvements will have resulted from the following two areas:
1. The people filling the forms in have a much better idea what sort of examples are needed and how to tell the story.
2. The people carrying out the assessments will have wanted to show improvements, and so marked more generously. After all, our lead assessor was the SHA CEO, and he won't have wanted the PCTs in his patch to be getting worse, especially and the assessments were carried out with the full knowledge that an election was around the corner.

The long and short of it is I suspect there has been little change in the quality of commissioning in our PCT (and I am not saying, or judging, how good or bad our commissioning is) over the past 2 years as a result of WCC. It has taken a LOT of directors and senior managers time, and therefore cost a lot of money, to go through the process. It has added little value, and amongst the many daft things AL is doing, scrapping WCC is certainly one bright moment!
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Anonymous | 12-Aug-2010 11:18 am
Easy to be good when the funding formula is massively loaded in your favour; expect to see them high up in the Dept of Health soon
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Anonymous | 12-Aug-2010 11:43 am
Anon 10.28 hits the nail on the head.
The introduction and monitoring of WCC has taken so much time and effort that the PCTs have actually not had the energy left to get on with their job of commissioning changes/improvements to their local services.
As a Provider I have had considerably less contact with my commissioning colleagues over the past two years whilst they measured themselves and flexed their muscles like a body-builder in front of a mirror. Roll on the days when front-line opinion is listened to and respected. -- When might this be?
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Anonymous | 12-Aug-2010 11:45 am
RE: 11:18 - I'm not sure about this year but in 2008/09 eight out of the top 11 PCTs were actually under allocation.
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Anonymous | 12-Aug-2010 11:51 am
Anon 10.28 - your local PCT seems to have missed the point. Building relationships with local providers was a key aspect of WCC - going beyond the formality of the monthly/quarterly review.

Of course they could also have commissioned services from another provider or within a community setting which is why you haven't seen them!
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Anonymous | 12-Aug-2010 12:39 pm
Anon 9:45 is spot on. An FoI on management consultancy spend for the top 20 by consulting organisation would be interesting...of course, I am not for one minute suggesting there is a correlation between spend on a (particular) organisation who also happened to be the protagonist in the assurance process.
No more looking in the rear view mirror - the skills required going forward do not exist in the NHS at scale....Have any of the CEOs run a business and delivered a profit? Different mindset please.
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Anonymous | 12-Aug-2010 2:31 pm
WCC is going. There are £billions of reasons why. Stop lamenting. If anyone thinks WCC delivered, I'll show you their socialist party membership card. Labour failed. WCC failed. DH failed. And they did it with my money so I voted for change and got it. I don't like everything from our two governments but the direction is principled and clear - unlike the past decade. Get over it and let's challenge what comes next not what's already dead.
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Anonymous | 12-Aug-2010 11:16 pm
Looks like Anon 10:28am has more commonsense and honesty than any of the directors in her PCT. GP Consortia like people with these attributes especially the insight and clarity that Anon 10:28 am has provided. I think Anon 10:28am would be the one who gets an offer she can’t refuse rather than any of her PCT directors and senior managers.
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Anonymous | 13-Aug-2010 8:09 am
anon 2.31 stop being childish, yes parts of WCC were flawed- obviously starting with its name but I agree with 10.25 "It was though the first serious attempt to define the role of the commissioner and set expectations for improvement. " There was starting to be some significant areas of improvement-forget the scoring, because, as with many form filling, some people are better at providing discriptors of these improvements than other. Change takes time if we have time to bed this in, even with the significant cost savings- which guess would mean the end to expensive consultants, I think that we would have started to start moving the tanker and make real improvements in services and outcomes for our population.
Lets face it the NHS has never had a reputation for being a completer finisher and part of the challenge of improvement is to maintain it while the goalposts of how we improve are being shifted from pitch to pitch
and no I'm not a member of the socialist party or any party- but I'm guessing from the terms you use- socialist and what you wrote re change perhaps indicates which part of the coalition you voted for.
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Anonymous | 16-Aug-2010 1:11 pm
Wasn't the point of WCC to pay huge sums of money to Auditors and management consultants? Some of the DH top brass who created it have gone to work for audit Companies even. It has resulted in extra staff appointed too, as happens with new fads, if people are already 100% busy then giving them something extra on top means more staff. Thats how PCTs become bloated. The costs outweigh the benefits - we even payed for expensive glossy posters to adorn our walls - for the benefit of the panel, noone else.
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Anonymous | 17-Aug-2010 3:38 pm
Our PCT did very well under the recent WCC assurance so here are my view positve and negative.

Can we separate two things. Firstly the WCC principle and secondly the WCC assurance process.

The pinciples relate to a set of qualities and competencies which effective commissioners should display. This seems to me to be a good thing.

The assurance process appeaered to emerge from the fantasy world of junior civil servant with OCD, a penchant for Sudoku, an inability to code a web page text box to accept more than 1000 characters and absolutly no knowledge of commissioning.

Are we better than we were. In some ways yes we are. The principles forced us to generate a strategy that genuinly linked population based needs assements with financial constraints and commissioning priorities. It challanged us to engage much more meaningfully with stakeholders and in particular it has given us a firm foundation for deciding locally what we are and are not going to do. A lot of the work that went into that has proved valuable to us as an organisation and to the population who rely on us to commission services appropriate to their needs.

... However. The process which we had to go through meant that a large number of people throughout the organisation were involved at times in some really silly activities i.e trying to get all the evidence about a meeting competency definitions into a thousand characters when the definition of each level was more than that. We also had to bring in external consultants to assist becuase we simply did not have the capacity to do everything that was necessary for WCC and keep the rest of the show on the road with new model contracts, new PBC commissioning intiatives etc.

A good idea - yes
Well executed - no
Of benefit to local people (not just patients) - partly
Value for Money - we will never know now
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