Leigh Griffin explains commissioning challenges faced by Greater Manchester and how the right support from CSUs can help to improve the region’s health

Greater Manchester is a complex health and care system. With a vibrant set of communities, it nevertheless contains several of the most deprived neighbourhoods in England and has profound financial and quality challenges. As a result, strong collaborative working between health and other public sector bodies is crucial.

‘Improving the health of our population is our clinicians’ top priority so doing this in a safe and cost effective way is vital’

From 1 April, commissioning support units have been established to provide at-scale expertise to the new commissioning system.

With around 500 colleagues serving 12 clinical commissioning groups, 10 local authorities and two area teams, Greater Manchester Commissioning Support Unit’s services were co-designed with its clients, and combine to ensure a secured income of £45m for 2013-14.

As a result of Greater Manchester’s significant health problems, the demand for medication is high and increasing, with costs of approximately £700m every year. Improving the health of our population is our clinicians’ top priority so doing this in a safe and cost effective way is vital.

The way forward

For several years now Greater Manchester Medicines Management Group has led the way in collaborative working, to which the CSU provides wide ranging support as part of our medicines management offer.

The medicines management group is made up of representatives from CCGs and hospital trusts across Greater Manchester, including GPs, pharmacists and other clinicians.

‘The success of this collaboration across the region has led to the formulary being shortlisted in the HSJ Awards’

Taking an innovative, region-wide approach to reduce variation, the group has developed a Greater Manchester Joint Formulary. This highlights the first choice drug, and alternatives, based on clinical evidence, adverse effects, suitability for the patient and cost effectiveness.

Greater Manchester Medicines Management Group is also responsible for the production of a “do not prescribe” list, kept up to date by Greater Manchester CSU. The aim of this list is to reduce prescribing rates of drugs deemed to be less suitable for prescribing due to safety, efficacy or cost effectiveness.

The list has provided the support to stop prescribing ineffective yet costly medicines. This has contributed to significant cost savings of up to £250,000 a year for each CCG for commissioners and providers.

Formulary success

One of the more innovative aspects of the formulary came in its creation, which took in the wealth of experience and views of the pharmaceutical industry, as well as the NHS organisations across the region.

This meant that there has been significant buy-in from all sides for the formulary, and that manufacturers have been encouraged to make their products more cost effective. One way of doing this is by offering a rebate scheme.

The medicines management team triages and manages the consideration of any rebate schemes on behalf of CCGs. We developed an ethical framework that can be applied across the board.

The rebate scheme is particularly intended for drugs included within the formulary and provides consistency of savings realised across the health economy. Drugs that are not on the GM formulary will be recommended to have any rebate rejected, as quality, safety and efficacy are prime considerations in optimising prescribing.

I am proud to say that the success of this collaboration across the region has led to the formulary being shortlisted in the Quality and Productivity category of the HSJ Awards.

Model of care

Our entry, “Delivering the impossible − prescribing consistently, cost effectively and to the highest quality standards to 2.8 million people across 12 CCGs and 13 trusts”, shows the high quality of innovation that can achieved by taking an at-scale approach.

In the near future I hope to see this example of best practice in Greater Manchester being the model of care for the whole UK and it’s certainly one that we are happy to assist other areas in developing.

‘Our inputs range from the design of new contract and financial models to hospital utilisation management reviews’

Medicines management is just one way that Greater Manchester CSU seeks to balance the advantages of at-scale support and expertise with the delivery of services bespoke to individual customer needs. For instance, we place ourselves centrally in the design and delivery of major service change, supporting local integrated health and social care programmes. Our inputs range from the design of new contract and financial models to hospital utilisation management reviews.

To make a difference in this area, we consider innovative approaches that can add value. This could be through developing cross-cutting contract options for the future to better support care pathways between agencies, or through taking advantage of systems that can improve the level of business intelligence we are able to offer.

Commissioning value

As the work we’re doing in medicines management and service redesign shows, we are seeking to maximise the value we add to commissioners, in an environment where both transactional efficiencies and transformational change are imperative.

Effective commissioning support is central to efficiency and, critically in this decade of constraint, the enablement of transformational change.

While, like all new organisations, we are tackling some teething problems, we are striving to bring together the respective strengths of the NHS and commercial sector approaches to drive value and enable change.

We have made a strong start, but there is much to be achieved in a short time to secure the support of our clients and to demonstrate the case for large scale commissioning support.

There are still many answers to be found and I suspect that all CSUs have three key questions at the front of their minds, about which I’d love to hear your thoughts:

  • How can CSUs provide at-scale efficiency and expertise while tailoring our services to local demands and needs?
  • How can we be both collaborative and competitive, supporting whole system change as a valued partner, while appropriately pricing and marketing our potential?
  • How can CSUs better enable innovation and the spread and consistency of good practice?

Leigh Griffin is managing director at Greater Manchester Commissioning Support Unit, @LGriffin_GMCSU