Commissioners, stakeholders and public are tackling health spend issues together within one primary care trust's strategic approach

Developing a commissioning strategy has been the catalyst for culture change at Oxfordshire primary care trust. The new strategic approach, says chief executive Andrea Young, is transforming the PCT from a reactive organisation, good at crisis management and meeting year-on-year targets, into a proactive one working with its population to develop a compelling vision of the future.

"The commissioning strategy has been a fantastic tool for liberating the organisation," says Ms Young. "We now have a story with which we can communicate with local people. It's a great platform for more meaningful dialogue with the public, stakeholders and staff about where we are going and what we want to achieve with our public."

The PCT is now taking the lead and not just responding to demands from above. "We are no longer going to local people and councils at the end of the process saying: this is what we have decided about your local services," she continues. "Local councillors in turn no longer see the NHS as something to criticise. They now see they can influence and take collective responsibility for delivering on some of these plans as active partners and they want to work with us in setting priorities and taking difficult decisions."

Relationships with the county council have been strengthened through pooling budgets, joint commissioning boards for children's and older people's services, joint needs assessments and joint appointments in key areas such as the director of public health.

PCT staff have been working with consultants on a number of interlinked strands: delivering the commissioning strategy and developing the operational and organisational development plans.

With the nine PCTs across NHS South Central now working well together, Ms Young says the world class commissioning programme has provided a common agenda.

"We have been able to learn from and support each other and to be honest and open about where our gaps are and where we would do better to address these equitably together," she claims.

"Joint business cases have been developed to improve capacity in quality and outcomes-based commissioning, information to support commissioning, public involvement and managing markets. We have been able to have mature discussions about the governance and resourcing issues of these collaborative arrangements."

Matching priorities

Three clear commissioning priorities emerged from widespread public and stakeholder consultation based on an assessment of where Oxfordshire PCT is now, how it spends its money, patient outcomes and population change over the next five to 10 years.

A better deal for older people

The health spend on older people is not being matched by health gains that would be expected, for example following emergency medical admissions. With the older population set to grow significantly this has been identified as a key area needing progress. The primary care trust is looking to work more proactively with patients and health professionals and help older people maintain healthy independent lives. Some care pathways will be redesigned with more care outside the acute sector and better use of community hospitals.

Breaking the cycle of deprivation

The PCT is working with the county council to reallocate resources more effectively for areas of Oxfordshire with greatest needs - where young people do not reach their health, social and educational potential. For example, health visiting is moving away from a universal service based on headcount to one based on need which works more closely with education and social care in 13 local communities.

Commissioning excellence

The PCT is working with GP practice-based commissioning groups and secondary care to marry resources to outcomes rather than episodes of activity, so it can be more confident about the return on its investment. Patients with long-term conditions such as diabetes will be empowered to know how to get the right support when needed.