David Peat on getting world class commissioning right

David Peat

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Call them benchmarks, standards or targets, it is no bad thing to have aspirations and the will to achieve. It is also good to be put on the spot sometimes, to help streamline the process and refine best practice.

The sooner you get it right, the better. As my maths teacher at Haslingden Grammar School always said: "Get it right first time, Peat." He also ran the soccer team and would bark instructions such as: "Round him, not through him, Peat."

His simple mantras have never left me and I thought of him when our primary care trust was chosen to pilot the world class commissioning project in the North West, along with four other PCTs. If we all get it right, it will help us and other NHS organisations when it is rolled out throughout the country.

Mounting pressure

But what is the programme all about? And why do we need it? The task in hand is to meet the growing health expectations of an ageing population suffering from more and more long-term conditions, at a time when that growth is not being met by the tax base.

The bottom line is there are more people to look after, more demands on the system, and fewer people to pay for it.

World class commissioning is one way to make step-changes in the way we commission services to meet these population needs and demands. It is a way of dealing with the time-bomb in our midst.

It might also be timely to remind ourselves of the "known knowns, known unknowns and the unknown unknowns", to use the terminology of former US defence secretary Donald Rumsfeld.

We all think we know the problems and some of the solutions but we were given a timely reminder recently of how you can misunderstand or misperceive public needs and preoccupations.

Public needs

We undertook a public survey with one of our five local borough councils, thinking beforehand that NHS dentistry would be the major issue. But it turned out that people were more concerned about access and drug abusers. They were frightened about the repercussions of drug use, ranging from concern for the people involved, to anti-social behaviour and the theft and break-ins used to pay for the habit. The survey results made us rethink and refocus our efforts.

As for the world class commissioning process itself, our director of strategic commissioning Cath Galaska is well down the track in getting to grips with it all. We are strong in some areas but need to shift up a gear in others. It can only do us good to have robust and regular needs assessments and knowledge management to see where we are and where we need to be.

Like all PCTs, among the major challenges are things such as the need to take reasonable risks to achieve our aim of going from good to great, as well as the role of boards and accountability. The role of clinicians has to be recognised fully, taking into account the undoubted strengths of GPs and other primary and community care specialists.

In the new environment, we will have to rethink the role of PCTs in the light of practice-based commissioning and how we target the particular needs of small areas and small groups of clients.

I think the trick will be to maintain inspiration and innovation in that ever-changing environment. Not easy, but neither was algebra at Haslingden Grammar.