If you are interested in engaging with commissioning you should discuss issues in the first instance via your medical staff committee, directorate meetings, divisional meetings and local negotiating committees before considering making direct contact with the Clinical Commissioning Group (CCG).
There are some areas which have been identified as clear points of engagement for consultants and senior SAS doctors who wish to influence the delivery of care in their specialist areas, or in the course of their work on behalf of by their Trust.
1. Positions on the CCG’s decision-making bodies
You should contact your CCG to find out about opportunities to get involved in the CCGs decision-making bodies. Co-opting secondary care clinicians onto specific subgroups of the CCGs should be encouraged, particularly when exploring service redesign.
Positions for secondary care clinicians on CCGs are regularly advertised on the NHS Jobs website.
The Government has decided that the statutory position for a secondary care doctor on the CCG board must be given to a secondary care clinician from outside the CCG’s area - this, says the Government, will avoid conflict of interest.
However, the BMA is concerned that this means that CCGs will not be able to take advantage of crucial local knowledge and expertise and has urged the Government to rethink.
2. Clinical senates and clinical networks
CCGs will also seek input from new Clinical Senates and Clinical Networks.
Clinical networks will be condition or service area specific and clinical senates will bring together a range of experts from different areas of health and social care.
Both senates and networks are intended to pool specialist expertise and thereby support the work of CCGs and will be hosted by NHS England.
3. LMCs and BMA Regional Committees
As a means of supporting the development of CCGs, the GPC is encouraging LMCs to build wider relationships with a number of organisations including local hospitals, mental health trusts and community services.
In turn, Regional Consultant Committees (RCCs) and Regional SAS Committees (RSASCs) should be encouraged to initiate contact with their equivalent structures in primary care to ensure an effective two-way dialogue takes place.
To be as effective as possible, we would advise you to engage in these wider relationships through your existing committee channels rather than making contact on an individual basis.
Where there is more than one hospital provider in the area, you would need to have discussions at directorate level to enable changes and new pathways to be implemented easily.
Once there is some agreement on the Trust structure for engaging with commissioning then someone, possibly the chairman of LNC, could be delegated to initiate
talks with the LMC and report back.
4. Regional Councils – dialogue with LMCs
Regional Councils are BMA bodies that bring together branches of practice into one setting. LMCs have been encouraged to build relationships with Regional Councils, particularly with consultants and public health doctors in mind.
This is a clear and definable route for you to engage in.
5. Local authorities
RCCs and RSASCs should contact their local authorities or health and wellbeing boards to initiate engagement and seek to influence decision making.
Each local authority upper tier will have a health and wellbeing board whose function will include encouraging integrated working between commissioners of NHS, public health and social care services.
These boards will also lead on commissioning decisions based on the Joint Strategic Needs Assessment (JSNA). Get more information about health and wellbeing boards.
6. Local Directors of Public Health
Under the new commissioning arrangements, responsibility and funding for public health will be allocated to local Directors of Public Health (LDPH) whose job will be to improve the health of local communities, through areas such as reducing the incidence of smoking and alcohol misuse and promoting physical activity.
LDPH (Directors of Public Health (DsPH) in the Public Health White Paper Healthy lives, healthy people: Our strategy for public health in England) will be transferred from the NHS into local government.
DsPH will support CCGs by helping to identify, prevent and manage a range of conditions but they will also need to have input into commissioning services for people with established diseases and long-term conditions.
The Department of Public Health (DPH) also intends to engage in a range of regular informal and formal mechanisms for public health experts to advise other NHS colleagues. While the nature of this engagement has yet to be defined, we would encourage you to seek engagement via existing committee channels.
7. NHS England
NHS England will provide overall leadership on commissioning - it has been operating in shadow form as a special authority since October 2011.
It will be responsible for:
- providing national leadership on commissioning for quality improvement
- promoting and extending public and patient choice
- ensuring the development of CCGs including holding them to account
- commissioning a range of services including national and regional specialised services.
Part of this responsibility will also involve developing high-level commissioning guidance for CCGs.
NHS England will be responsible for commissioning services on behalf of CCGs who are not deemed ready for authorisation by April 2013.
The BMA has successfully lobbied to change the role of Monitor away from promoting competition.
The Health and Social Care Act now states that Monitor's main duty is to regulate healthcare providers, regulate prices for NHS services and address restrictions on competition that act against patients’ interests.
Part of this function will include supporting the delivery of integrated services for patients where this would improve quality of care or efficiency or reduce inequality of access or outcome for patients.
Monitor will operate a licensing regime allowing it to enforce standards by setting out how providers should operate. All providers of NHS healthcare services, unless exempted, will be required to hold a licence with Monitor.