David Nicholson tells NHS: improve first, then prove it

Mr Nicholson said the operating framework contained clear goals for improving commissioner capability, with the requirement that commissioners reach level three - national best practice - in seven of the 11 world class commissioning competencies  by 2011.

I’d just suggest that you go out and do the job really, and the evidence will flow from that,

He also promised “support for high performers to lead on quality and productivity” from April 2010 and called for more joint work between commissioners to “increase leverage and realise economies of scale”.

However, while urging commissioners to up their game on achieving the competencies in practice, he said they should be spending less time on bureaucracy to prove that they were.  

Mr Nicholson said: “The whole purpose of [world class commissioning] is to improve commissioning, not to fill lever arch files full of evidence.”

He said he had asked Department of Health director of commissioning Gary Belfield to look at how the programme might be streamlined to achieve this.

Mr Belfield echoed Mr Nicholson’s sentiments this month at a Primary Care Trust Network commissioning conference in London.

He said: “I go into PCTs and I still find that they’re collecting the minutiae to show that they’ve got the competency 3 part C. We just don’t want that this year.”

He said he wanted commissioners to “revamp, rewrite, redraft, and refresh” their strategies so they reflected the new “financial reality”. The next round of world class commissioning panel days - due in March and April - would focus around 80 per cent on strategies and less than 10 per cent on competencies.

“I would really encourage you not to spend all your time at your desk collecting competency evidence and I’d just suggest that you go out and do the job really, and the evidence will flow from that,” he said.

He added: “We’re expecting a lot from you and we expect you to get there quite quickly. We hoped year two of the WCC approach would still be pretty developmental but because of the financial changes coming round the corner I think we just don’t have that luxury.”

He suggested that year three of the programme might be a “really light version” with a focus on patient outcomes rather than competencies or strategies.

PCT Network director David Stout said while the comments about collecting evidence had the right sentiment it was not that easy in practice for commissioners, as they had to demonstrate competence in everything rather than just give examples.

He said: “The process of being able to prove that is a major exercise in collection and collation of evidence. PCTs in some parts of the country are finding it a cumbersome process this year.”  

But NHS Birmingham East and North chief operating officer Andrew Donald agreed with Mr Nicholson. He said: “If you focus on the competencies you miss the point.”