Local commissioning: DoH sets out skills PCTs will need

Draft documents now circulating among senior PCT staff mark the first attempt to define world class commissioning. The authors, Mark Britnell, director general of commissioning at the DoH, and Gary Belfield, director of commissioning, insist these have been developed in collaboration with the NHS rather than in consultation. Mr Belfield told HSJ: ‘This is very much a co-production and we are still developing it.’

The DoH hopes to publish the documents formally in early December. A pilot of the competencies begins in the North West next month.

The vision sets out what world class commissioners should look like and describes the skills they will need (see list below). The draft document, Adding Life to Years and Years to Life, also justifies the decision to use the phrase ‘world class commissioning’. This, it says, marks an intent to create a ‘new form of commissioning’, leading the way among developed healthcare economies.

North Yorkshire and York PCT director of public health Dr Peter Brambleby said: ‘The vision has put adding life to years first and it’s exciting to see the penny drop about the significance of that.’

The document says: ‘In some areas of expertise, competence will have to be learned from or commissioned in from external agencies and other industries.’

PCTs must have highly visible leaders and work through partnerships with others such as local authorities. That, the paper argues, will put the patient at the centre of work to improve health outcomes.

Picker Institute chief executive Angela Coulter said engaging patients would be vital. ‘Commissioners need to get beyond talking to the usual suspects,’ she said. Rotherham PCT chief executive Andy Buck said: ‘Probably the greatest challenge for PCTs is to find radically better ways of seeking out and acting on public and patient expectations and experience.’

The document envisages PCTs with high levels of clinical engagement, which it says is ‘integral to the process of commissioning’.

Mr Belfield said that practice-based commissioning would be ‘at the heart’ of world class commissioning. PCTs must also have high levels of financial expertise and information management. They will be expected both to develop new markets and manage them.

NHS North West will pilot the framework from mid-November. Chief executive Mike Farrar said information management and health economics were two areas in which the strategic health authority might find it needed more expertise.

‘Key things will be how we measure fairly and looking at the outcomes to see if they are what we anticipated,’ he said.

The pilot is expected to last for three to six months, with initial findings reported to the DoH and SHAs after three months.

NHS Confederation PCT network director David Stout said: ‘This is the first time we have had a coherent sense of what commissioning means and where we are trying to get to.’

The assurance regime to monitor PCTs’ progress on commissioning is the least developed part of the project so far.

HSJ understands it is likely to involve some self assessment, some peer review and some hard metrics which SHAs would use to call PCTs to account.

Berkshire East PCT chief executive Lise Llewellyn said: ‘The government and the NHS has got to be realistic about this, we are not going to have world class commissioning by next April - they need to set a realistic timescale.’

The skills PCTs need

• leadership;

• engagement;

• knowledge management;

• strategy development;

• market development;

• contracting and procurement;

• finance.

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