With the recent launch of the Department of Health’s world class commissioning agenda, there is increased pressure on primary care trusts to manage their budgets effectively while at the same time improving public health and patient satisfaction.

However, many PCT staff have not had specific training in commissioning, and sometimes little experience of the specific dynamics of the local healthcare economy in which they work.

In practice, this means a reluctance to venture outside of their commissioning comfort zone, despite there being innovative and effective ways that could lead to better run and more resourceful PCTs and, ultimately, better local health outcomes.

Seeing this gap in skills, and recognising PCT staff as an untapped resource of talent and innovative thinking, Humana and Sweden-based BTS, came together to develop a simulation exercise that engages PCT staff and boosts confidence in making long-term strategic commissioning decisions.

Under the umbrella of the Commissioning Institute, the Commissioning Simulator was born – an interactive and multi-faceted computer simulation programme based on a similar model to that of the popular PC game Sim City, designed to help people move out of their comfort zone and develop a broader view of their local health economy in a risk-free environment.

The aim of the Commissioning Simulator is to enable people who work in a local healthcare economy to practice taking important commissioning decisions in unfamiliar situations and to take risks they would normally not feel comfortable taking in the real world. The Commissioning Simulator replicates the conditions and variables of commissioning in a virtual environment and maps the implications and outcomes of decisions across a set time period, based on the population demographics of a realistic PCT area.

The simulation effectively illustrates how multiple strategic decisions by competing stakeholders in a healthcare economy interact to produce changes in patient outcomes and experience and financial position. The simulator helps participants to broaden their understanding of how different stakeholders may be thinking and to take a ‘system view’ when considering their own decisions.

At the first Commissioning Simulator workshop at Gloucestershire PCT, four teams of seven people worked for two days on a series of scenarios and predictive modelling tasks replicating the construction of a commissioning strategy over a three-year business cycle. Challenges included managing healthcare pathways, reducing obesity and improving mental health, with limited funds and time.

Participants, many of whom had little or no previous experience of commissioning, found the experience challenging but very positive. They felt that the structure of the programme allowed them to think through and discuss complex decisions with their colleagues, and gave them an overview of the implications of short-term decisions on the whole commissioning cycle.

One participant remarked that the simulator gave them an opportunity to consider the whole commissioning process in the context of PCT operations and made them realise that everybody who worked in a PCT was a commissioner.

Reflecting the development and aims of the Commissioning Simulator, its director David Goldberg said, “The Commissioning Simulator enables stakeholders in a local health economy to collectively address how to improve the health of their population. The learning and relationship building transcends the simulation session and affects how commissioning is conducted."

The Commissioning Simulator launched in March and will be implemented across the UK over the coming months.

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