Clinical Commissioning Groups – Beyond Authorisation
Hosted conversations – summary of projects/programmes
Emma Baylin, Bradford CVS
Supporting partnerships that improve health and wellbeing
HPP helps the Voluntary and Community Sector (VCS) to work in partnership with the statutory sector to tackle health inequalities and improve delivery of health services.We also ensure that knowledge and evidence from the VCS is utilised when designing services, strategies and commissioning.
GP Signposting
VCS groups expressed concerns that GPs did not understand or value the offer from VCS services and rarely signposted patients to them. Groups were concerned that under GP led Clinical Commissioning Groups (CCGs) the VCS would be forgotten and funding at risk. GPs had also expressed frustrations about the impossibility of navigating the voluntary and community sector (VCS) to find appropriate support for the significant number of patients who attend surgery with non-clinical concerns. To begin to address these concerns, Health Partnership Project (HPP), ran a pilot with 2 GP surgeries. Firstly, we asked GPs to identify what problems and concerns patients were presenting to them. We looked at the large proportion of these which were non-medical and used this as a basis for mapping VCS services. We produced an online directory which provides information on VCS services within specific localities under the category headings identified by GPs: Family Support, Lifestyle and Weight Management, Long Term Conditions, Mental Health, Money, housing and legal, Older people’s Services, Social Activities, Transport.
We worked with the emerging CCGs to ensure that the tool was embedded into SystmOne- the electronic patient record. This means that during an appointment a GP can access up-to-date information on local VCS services at the click of a button. The information can be provided to a patient in the form of an “information prescription”. This supports the cultural change necessary to ensure that the VCS is recognised as a legitimate part of a patient’s health-care options and supports the tackling of health inequalities by enabling people to address the causes of ill-health.
We have continued to refine and update our systems and to date have trained over 100 staff from GP surgeries, over 100 social workers and a number of hospital clinicians.
The work has been described by GPs as an “elegant and simple” solution to a difficult problem and an “exciting and positive prospect". One GP explained, “It is really helpful in knowing what is out there to help patients properly who are currently inappropriately attending their GP".
Health and Wellbeing Hubs
HPP in partnership with LA Neighbourhood Services and PCT Community Engagement team created 5 Health and Wellbeing Hubs covering Bradford and Airedale constituencies. These Hubs bring together service providers from across sectors to: 1) identify local health and wellbeing needs, 2) take action through a partnership approach and 3) feed information through to strategic platforms in order to influence strategic and commissioning decision making. Hub memebers were keen to engage with emerging CCGs
CCGs have a need to engage with their local communities. HPP advocated for the positive role the VCS could play in assisting CCGs in this and the way the Health and Wellbeing Hubs could suport this process. The CCGs began a comprehensive process of engagement with the hubs, setting the scene of CCG development and structures and hearing in return about local issues and concerns from service providers on the ground.
The developing dialogue and relationship led to an event bringing together approximately 100 workers from VCS and statutory frontline services to check Bradford District CCG’s commissioning intentions against participants‘ practical experience and detailed knowledge of the area and population. It was held to ensure the health and wellbeing needs of diverse communities in which they work were heard and utilised in the setting of the strategic priorities of the CCGs. These priorities will, in turn, inform the commissioning intentions for 2013/14.
The key themes raised through the discussions were taken directly into the governing body meeting of Bradford Districts CCG (which was running in parallel) in order to help steer the commissioning priorities for the next round of contractual negotiations. The report was circulated to both District and City CCGs, Public Health, JSNA Steering Group as well as Hub members and event delegates.
“It was really important for us all to engage openly and transparently and there was a really positive focus on supporting communities to help themselves. It was really powerful to be able to feed the themes raised straight into the meeting of our governing body.” ~ Richard Haddad, Bradford District CCG
“It is vital for us as commissioners to get a better insight into the needs and priorities of our local populations and identify any gaps. The input we had from the voluntary sector, patient groups and other partners is invaluable in helping us shape our commissioning priorities.” ~ Waheed Hussain, elected GP on Bradford City CCG
For more information go to www.healthpartnership.org.uk or email
Barry Knowles, Voluntary Action Rotherham
Barry works for Voluntary Action Rotherham as Project manager for the Rotherham Social Prescribing Service.
The Social Prescribing Service is the VCS component service of GP case management teams for patients with long term conditions in Rotherham. Barry is Project Manager and they have five front line workers (known as VCS Advisors) who attend case management meetings in GP Practices then visit patients referred by GPs to explore social solutions to identified issues such as loneliness, low confidence, financial problems, poor mobility and the needs of carers.
VCS Advisors refer patients on to VCS services where appropriate to their social needs. They have funding to support VCS providers to build capacity to meet the identified needs of referred patients. All patients referred to their Advisors are referred by GP Practices participating in this pilot project, funded by NHS Rotherham initially for two years (until March 2014).
Twenty nine of thirty six GP Practices in Rotherham are taking part in the pilot and GPs have a separate funding agreement with NHS Rotherham. They have a GP led Steering Group (mainly operational) with a remit to direct the pilot and ensure integrated working is effective.
Case Management Teams for the long-term conditions pilot typically consist of:
· GP
· Community Matron
· Distict Nurse / Practice Nurse
· Social Worker
· VCS Advisor
Questions for delegates:
1. How as a VCS sector organisation do you engage with GP Practices effectively?
2. Do you think integrated working helps patients? (share good practice on effective integrated working)
3. What are the barriers to integrated working between health professionals, social care professionals and VCS professionals?
Helen Garforth, IVAR, lead facilitator of the VCSE Health Commissioning Improvement pilot programme
The Health Commissioning Improvement programme provides practical tools and guidance to improve partnership working between Health and Wellbeing Boards, Clinical Commissioning Groups and the Voluntary, Community and Social Enterprise Sector. Working on a bespoke basis the programme makes sure that the right people are in the room, to address key local challenges, facilitate discussion and joint work to deliver better partnerships. More effective partnerships lead to integrated working and improved health outcomes, for lower financial costs but greater social value. It is a Department of Health funded programme delivered by IVAR and SEUK.
Caroline O’Brien, Chief Officer for Cheshire East CVS (and VCSE HCIP pilot)
The Health Commissioning Improvement Programme
The pilot HCIP funded by the Department of Health and delivered by Social Enterprise UK and the Institute for Voluntary Action Research was conceived as a twelve month programme of work. This was alongside and with the developing health structures, the overarching aim of the programme is to support Clinical Commissioning Groups and Health and Wellbeing Boards to develop constructive and productive partnerships with VCSE sector organisations through:
· Developing and supporting the role of VCSE sector organisations within Health and Wellbeing Boards;
· Providing advice and support to Clinical Commissioning Groups on the role and contribution of VCSE sector organisations; and
· Ensuring that VCSE sector organisations have the capability to respond to patient needs and emerging commissioning requirements.
Cheshire
“We recognise the need for a changing culture but there is less recognition of the time it takes to do things like build consortia, develop trust, form the relationships needed to commission differently.”
The issue:
The Cheshire group felt that one way to promote different attitudes – a ‘culture change’ – to involving VCSE organisations throughout the commissioning cycle was to focus on social value, analysing the cost benefits as well as the wellbeing benefits of involving VCSE organisations in support and prevention. Alongside this, the group looked at potential VCSE involvement in a number of patient pathways, and identified ways of working that might prevent costly clinical intervention in a number of areas.
The emerging action:
Master-classes on the Public Services (Social Value) Act. This practical learning session examined the implications for all public bodies which now have to consider how the services they commission and procure might improve the economic, social and environmental well-being of their area. Building on this understanding, participants from across the sectors explored how to articulate the social value of a number of potential interventions locally, using the patient pathways as a starting point.
The desired outcome:
A greater understanding locally of commissioning for social value, and of how VCSE organisations can play a role in enabling commissioners to meet their requirements under the Public Services (Social Value) Act. This would build the capacity of VCSE organisations to articulate the benefits of VCSE engagement in health commissioning and delivery, and promote a thriving VCSE sector providing integrated health care alongside other service providers.
What else is happening here as a result of the pilot programme?
· A fact sheet for Commissioners on local VCSE organisations is being jointly produced by the CVS and the CCG
· A GP is pursuing the involvement of local VCSE organisations in the Partnership Board and the Patient and Clinician Forum, and the potential to include a Q&A session with local VCSE organisations at a GP education session in one of the PLZ (Protected Learning Zones)
· A joined up approach at an October event for the VCSE and commissioners, focusing on the JSNA
· VCSE organisations will explore the notion of a coordinator in the locality teams of the CCG to inform decisions and act as a conduit for information back to the sector.
Catherine Mills, Clinical Projects Manager, NHS South Cheshire and Vale Royal CCGs (and VCSE HCIP pilot)
The Health Commissioning Improvement Programme.
The pilot HCIP funded by the Department of Health and delivered by Social Enterprise UK and the Institute for Voluntary Action Research was conceived as a twelve month programme of work. This was alongside and with the developing health, structures the overarching aim of the programme is to support Clinical Commissioning Groups and Health and Wellbeing Boards to develop constructive and productive partnerships with VCSE sector organisations through:
· Developing and supporting the role of VCSE sector organisations within Health and Wellbeing Boards;
· Providing advice and support to Clinical Commissioning Groups on the role and contribution of VCSE sector organisations; and
· Ensuring that VCSE sector organisations have the capability to respond to patient needs and emerging commissioning requirements.
Cheshire
“We recognise the need for a changing culture but there is less recognition of the time it takes to do things like build consortia, develop trust, form the relationships needed to commission differently.”
The issue:
The Cheshire group felt that one way to promote different attitudes – a ‘culture change’ – to involving VCSE organisations throughout the commissioning cycle was to focus on social value, analysing the cost benefits as well as the wellbeing benefits of involving VCSE organisations in support and prevention. Alongside this, the group looked at potential VCSE involvement in a number of patient pathways, and identified ways of working that might prevent costly clinical intervention in a number of areas.
The emerging action:
Master-classes on the Public Services (Social Value) Act. This practical learning session examined the implications for all public bodies which now have to consider how the services they commission and procure might improve the economic, social and environmental well-being of their area. Building on this understanding, participants from across the sectors explored how to articulate the social value of a number of potential interventions locally, using the patient pathways as a starting point.
The desired outcome:
A greater understanding locally of commissioning for social value, and of how VCSE organisations can play a role in enabling commissioners to meet their requirements under the Public Services (Social Value) Act. This would build the capacity of VCSE organisations to articulate the benefits of VCSE engagement in health commissioning and delivery, and promote a thriving VCSE sector providing integrated health care alongside other service providers.
What else is happening here as a result of the pilot programme?
· A fact sheet for Commissioners on local VCSE organisations is being jointly produced by the CVS and the CCG
· A GP is pursuing the involvement of local VCSE organisations in the Partnership Board and the Patient and Clinician Forum, and the potential to include a Q&A session with local VCSE organisations at a GP education session in one of the PLZ (Protected Learning Zones)
· A joined up approach at an October event for the VCSE and commissioners, focusing on the JSNA
· VCSE organisations will explore the notion of a coordinator in the locality teams of the CCG to inform decisions and act as a conduit for information back to the sector.
Patricia Coker, Head of Partnerships and Performance, Central Bedfordshire Council (and VCSE HCIP pilot)
The Health Commissioning Improvement Programme
The pilot HCIP funded by the Department of Health and delivered by Social Enterprise UK and the Institute for Voluntary Action Research, was conceived as a twelve month programme of work alongside and with the developing health structures. The overarching aim of the programme is to support Clinical Commissioning Groups and Health and Wellbeing Boards to develop constructive and productive partnerships with VCSE sector organisations through: