Alastair Whitington, Consultant Editor for Specialised Commissioning, explains why joint working should not be viewed as collaboration with the enemy
Welcome to the November 2019 issue of Specialised Commissioning—a publication that highlights best practice, opportunities, and challenges in the commissioning and provision of specialised healthcare.
Too often in the NHS, joint working is viewed as collaboration with the enemy rather than working in partnership to successfully achieve an aim. However, collaborative commissioning is key to the future delivery of specialised services. The Manual for Prescribed Specialised Services 2018/19 outlines which elements of the 149 specialised services are commissioned and funded by NHS England, and which are commissioned and funded by CCGs.1 For the majority of the specialised services commissioned by NHS England, the care pathways include services commissioned and funded by CCGs and local authorities. Shared objectives, joined‑up planning, and coordinated investment are necessary if these services are to efficiently and effectively deliver the expected outcomes.
There are inevitable risks if commissioning is not joined up, as illustrated by the management of severe and complex obesity. When it was created in April 2013, NHS England became responsible for surgery for severe and complex obesity. As part of the eligibility criteria for surgery, patients were expected to have completed tier-3 specialist weight-management programmes commissioned by CCGs.2 When insufficient tier-3 programmes were commissioned by CCGs, there was a significant impact upon patients’ eligibility to have surgery, resulting in considerable under-delivery of surgery for severe and complex obesity over 3 years. This was subsequently resolved through the publication of guidance,1 and the transfer of responsibility for the total pathway to CCGs.
NHS England contracting guidance for 2019/20 recognises how ‘This split in responsibilities and associated budget can sometimes lead to misaligned incentives, underinvestment in upstream or preventative interventions and fragmented care for patients’.3 Acknowledging that not all pathways can be transferred, the guidance has set the objective for 2019/20, through Sustainability and Transformation Partnerships and Integrated Care Systems, that all local health systems should have an advisory role on NHS England-led specialised services planning boards. Each planning board will focus on services where there is a clear overlap with locally commissioned services, which may include mental health and learning disability, cancer, renal, and some cardiovascular services. Although, under current legislation, NHS England will retain formal responsibility for the commissioning of specialised services, better integration with local healthcare systems may be achieved through pooled budgets, joint appointments, and delegation of responsibility, such as in the Greater Manchester Health and Social Care Partnership.4
The need for commissioners and providers to work together is highlighted in one of three feature articles in this issue. In their article on the commissioning of epilepsy care, Professor Tony Marson and Dr Pete Dixon discuss the practical challenges facing specialised commissioners in improving and expanding epilepsy services.
Neli Garbuzanova explains how the early strategic use of procurement can benefit specialised commissioning. This feature article also covers the importance of pre‑procurement planning, research, and design, and provides practical tips on successful procurement.
Following the publication of guidance on mechanical thrombectomy for acute ischaemic stroke, Professors Gary A Ford, Martin James, and Phil White outline the service reconfigurations, collaborative working, and benefits to patients and the NHS associated with implementing a mechanical thrombectomy service across the UK.
Our feature story details the joint working between industry and the NHS necessary to realise the enormous potential of cell and gene therapies. In their article, Eric Low and Sally‑Anne Tsangarides discuss aspects of the development and appraisal of cell and gene therapies, barriers to their implementation, and the importance of involving patients in their evaluation.
We also bring you highlights from the Westminster Health Forum on Cancer Care in England, which covered the implementation of cancer policy in England. Finally, in our regular Medicines Corner column, Martin Bradley discusses the new Commissioning for Quality and Innovation indicator on antifungal stewardship.
As we celebrate our second anniversary as the leading healthcare publication focused on specialised services, we have taken the opportunity to consider the future. In 2020, building on our strengths, Specialised Commissioning will become Specialised Medicine: in addition to the commissioning of specialised services, our focus will expand to bring you more clinical articles, best-practice pathways, and guidance updates relevant to the implementation of specialised medicine. We will continue to encourage debate, pose questions, seek answers, and challenge those who work in specialised services to push further, collaborate more, and realise their collective potential.
- NHS England. Manual for prescribed specialised services 2018/19. London: NHS England, 2018. Available at: www.england.nhs.uk/publication/manual-for-prescribed-specialised-services/
- NHS England. Guidance for Clinical Commissioning Groups: clinical guidance: surgery for severe and complex obesity. London: NHS England, 2016. Available at: www.england.nhs.uk/wp-content/uploads/2016/05/appndx-7-obesity-surgery-guid.pdf
- NHS England. NHS operational planning and contracting guidance 2019/20. Annex E—integration of specialised services with local health and care systems. London: NHS England, 2018. Available at: www.england.nhs.uk/publication/preparing-for-2019-20-operational-planning-and-contracting-annex-e-integration-of-specialised-services-with-local-health-and-care-systems/
- Greater Manchester Health and Social Care Partnership. Partnership agreements. www.gmhsc.org.uk/about-devolution/partnership-agreements/ (accessed 12 November 2019).