Background
Evidence on the effectiveness of commissioning in enabling change in health and social care
Commissioning in the English NHS
Joint commissioning of health and social care
Whole systems integrated Care in North West London
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People will be empowered to direct their care and support, and to receive the care they need in their homes or local community.
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GPs will be at the centre of organising and coordinating care so that it is accessible and provided in the most appropriate setting.
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Systems will enable and not hinder the provision of integrated care, and ensure that funding flows to where it is needed most.
Methods
Study design
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how the WSIC programme was designed;
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the involvement of local stakeholders in the design process;
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the development and early implementation of early adopter (EA) schemes; and
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the extent to which the WSIC programme appeared to be on track towards its objectives.
Phase | Main research tasks | Data collected |
---|---|---|
Phase 1 – February to June 2014
Describing, understanding and assessing the context and processes of WSIC
(Objectives 1&2)
| Assess co-design of the programme | Research co-design workshop (re overall objectives and approach) 30 × 1-h interviews |
Involvement of stakeholders in co-design | Observation field notes of 60 hrs of meetings or workshops Analysis of programme documentation including WSIC toolkit Review of UK and international literature on integrated care and commissioning Feedback workshop with WSIC stakeholders re initial findings | |
Phase 2 – July 2014 to April 2015
Tracking progress of 9 EA schemes and in-depth case studies of 4 EAs, plus ongoing programme-level monitoring of context
(Objectives 3&4)
| Development and early implementation of EAs | Research co-design workshop with EA and WSIC stakeholders (re case study approach and selection) 16 × 1 h interviews at pan-NWL level 27 × 1-h interviews in case study EAs Field notes of 60 hrs of meeting observations both in EA case studies and at pan-NWL level Continued analysis of programme documentation On-line survey of members of EA steering committees On-line survey of all GP practices in NWL Feedback workshop with EAs re survey and other data initial findings |
Progress made towards WSIC objectives | Synthesis by research team of all data Comparison of conclusions with WSIC plans Feedback workshop with WSIC core leadership team to share draft report themes and framework Feedback workshop with WSIC stakeholders to share final draft report |
Data collection
Data analysis
Limitations of the research methods
Results
Strategic role of commissioning
Local authority adult social care | Local authority public health | CCG | NHS England (London) | |
---|---|---|---|---|
Extremely involved | 14% | 5% | 57% | 3% |
Very involved | 44% | 25% | 30% | 12% |
Moderately involved | 24% | 3% | 9% | 23% |
Slightly involved | 15% | 39% | 2% | 32% |
Not at all involved | 4% | 27% | 1% | 30% |
Total
|
100%
|
100%
|
100%
|
100%
|
N
|
80
|
59
|
82
|
77
|
Patients, service users, carers | Lay partners | Voluntary sector representatives | NHS front line staff | WSIC programme team | |
---|---|---|---|---|---|
Extremely involved | 35% | 39% | 25% | 9% | 51% |
Very involved | 31% | 39% | 48% | 22% | 32% |
Moderately involved | 26% | 14% | 20% | 48% | 16% |
Slightly involved | 7% | 8% | 7% | 20% | 1% |
Not at all involved | 1% | 1% | 0% | 1% | 0% |
Total
|
100%
|
100%
|
100%
|
100%
|
100%
|
N
|
81
|
80
|
81
|
81
|
81
|
Relational and transactional elements of commissioning
Role of GPs and primary care in commissioning
Commissioning and culture in health and social care
Discussion
Commissioning integrated care in north West London
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significant effort went into engaging some people at some levels in plans for change;
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the project planning approach was extensive and included apparently rigorous ‘checkpoints’ and monitoring;
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WSIC built on prior integrated care and community budgeting initiatives locally, as well as participating in national pilot schemes;
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the WSIC programme was located within a policy of primary care-led commissioning committed to strong general practice involvement; and
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there was a major commitment to recruiting, training and working with lay partners.
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successful engagement of front-line health and social care staff, their managers and union representatives in detailed planning for new ways of providing and staffing services;
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involvement of local politicians in WSIC planning and governance;
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setting graduated and realistic outcome measures;
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learning sufficiently from prior local experience of pilots that had demonstrated the time required to change service delivery patterns across multiple professions and the limited prospects of affecting emergency admission rates;
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engaging the majority of clinicians employed in community and hospital settings in the implementation of EAs; and
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involving the public, patients and carers in actual implementation of service change, as opposed to having intensive but narrow engagement in programme planning and governance.
The potential and limitations of commissioning in delivering large-scale change and integration
Conclusion
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define specifically what changes to services are intended;
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convene stakeholders to plan for and support implementation continuously; and
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see outcomes as something for which commissioners and providers are jointly accountable.