The NHS Commissioning Board Authority has taken on the key functions and expertise for patient safety from the National Patient Safety Agency (NPSA).

The move is an attempt to drive patient safety to the heart of the NHS whilst improving standards of care.

The Board will use the NPSA’s database of patient safety information to identify and correct important safety issues.

Working across different sectors, the Commissioning Board Authority aims to utilise patient incident data to assess risk, improve learning and overall safety.

Despite the switch, healthcare organisations should continue to report any patient safety incidents to the NPSA.

Prospective CCGs are to be assessed on their commissioning intentions for 2013–14 as part of the CCG authorisation process, latest guidance from the NHS Commissioning Board Authority (NCBA) has revealed.

Applicants will need to submit key documentation such as Joint Strategic Needs Assessment plans and Health & Wellbeing Board strategies as part of a robust review process.

The shadow organisations will also need to provide a list of collaborative commissioning arrangements, joint commissioning agreements and any 2012–13 contracts approved via PCT clusters. An Integrated Plan for the current year will also be assessed.

The parameters for assessment are outlined in a new guide issued by the NCBA: Clinical commissioning group authorisation: draft guide for assessors undertaking desk top review, which is designed to support assessors participating in the CCG application process. The guide focuses on the first phase of NHSCB assessment, ‘desk top review’, the completion of which will lead to the production of a key reference document to support CCG authorisation.

The guide follows the April publication of a draft guide for applicants and aims to ensure that evidence submitted by CCGs is assessed ‘transparently, consistently and fairly’. It outlines assessors’ roles within the authorisation process, its overarching principles and methodology, and the criteria by which evidence submissions should be judged. This evidence, it says, should be a ‘by-product of core business’ for CCGs.

Full details of the authorisation process at the desk top review stage are available here.

Serco has been contracted to provide NHS community health services to 600,000 patients in Suffolk.

The service company will take over the provision of adult community services, specialist children’s services and community hospitals from NHS Suffolk by the autumn.

As the prime contractor, Serco will deliver services in partnership with South Essex Partnership University NHS Foundation Trust (SEPT), Marie Curie Cancer Care, Bedford Community Dental Services and University Hospital Birmingham. It will take on staff from the current NHS provider organisation, Suffolk Community Healthcare.

According to Serco, the company will employ “a unique model of delivery” to improve access to services for rural communities in Suffolk.

Dr Paul Watson, Chief Executive of NHS Suffolk, said: “Serco has provided us with a detailed proposal, giving rigorous evidence of its experience as a service provider and its vision and innovative plans for further improving our community services.”

“Over the coming years, primary care colleagues from across Suffolk will be working closely with Serco, NHS Suffolk and our acute hospital trusts so that we can make sure patients receive truly integrated, joined-up services,” said Dr Paul Bethell, a GP involved in the selection process.

Paul Forden, Serco’s Managing Director of Acute & Community Services, commented: “Our integrated model of care is possible by bringing together the best of the NHS, voluntary and private sector. We believe that our partnership approach brings the vision, expertise and capacity to make Community Health in Suffolk a truly exemplary service.”

A local information strategy is key to successful account management. The data is out there. Rhiannon Thomason explains how turning information into insight is all about context.

Despite reforms that appear to encourage decision-making and accountability at a local level, the UK health service remains a national one. The Health & Social Care Act actually strengthens the centralised power-base and, via the NHS Commissioning Board, issues a series of top-down directives that will cascade to a local level for implementation. Rumours of the death of the ‘N’ in our NHS are grossly exaggerated. But for Key Account Managers across the UK pharma industry, what happens at a local level is perhaps the prime focus. There is much talk of the need for ‘local health intelligence’. It is indeed a vital commodity. But it is important to draw the distinction between information and insight. The former is readily available. The latter is hard won and impossible to achieve in isolation. In the battle for local health intelligence, context is King.

The NHS is awash with data. Nowadays there is much more information available and the health service itself is increasingly placing useful data into the public domain. Examples such as QOF data, Joint Strategic Needs Assessments, HES (Hospital Episode Statistics) data, the Atlas of Variation and Public Health observatories provide a rich seam of information from which sales and marketing professionals can develop appropriate local messages. They combine to form a complex matrix of information. The challenge for KAMs is interpreting it and understanding what it means in their disease area and in their locality. There is variation right across the system.

In primary care, QOF data has become increasingly important. NHS customers are being tasked to reduce unnecessary hospital admissions, and the financial incentives from a local practice perspective are significant. But as the transition towards Clinical Commissioning Groups continues, practices know that they cannot work in isolation and that they must prove to the wider organisation that they are achieving their targets.

For the industry, QOF indicators have become a catalyst for improved customer engagement. Proactive sales professionals are no longer targeting GPs with messages based only on the clinical benefits of their products. They are instead identifying key local decision-makers and attempting to demonstrate how their product can impact a service, reduce hospital admissions, save a locality money and improve patient care.

Clearly, QOF data has become a strong lever for account managers to understand how their product can help customers meet their targets. In isolation however, the data can only take you so far.

When used in combination with other available information, a much more powerful package of metrics can emerge.

Sales professionals need to build the bigger picture of what is going on at a local level, to understand how their products can make a difference. This depends upon drawing together all the various strands of information, and developing value propositions based on the local context as a whole.

• How is each local health economy constructed? Which organizations are operating within each locality? What are the roles/responsibilities of each and how do they engage with one another? Who are the key stakeholders?
• What is the community profile? How many patients are there? What are the deprivation and ethnicity breakdowns?
• What is the patient pathway? What services are provided, by whom and how are patients managed?
• What is the cost of hospital activity? How much does each group of patients cost each locality?
• What are the outcomes? How much is each locality spending and how well are they managing each group of patients? How can the outcomes be measured?

The trick for pharma is to be able to use all of this information intelligently, in combination. Much of it is publically available, but without the knowledge and understanding of how it translates into what you are trying to achieve, it could, in a worse case scenario, send the sales professional in the wrong direction.

Variation in care
In a complex environment where context is everything, it is important not to lose sight of the bigger picture on a national scale. Many of the challenges being faced by local commissioners on the ground are around the treatment of diseases identified as national priorities. The implementation of commissioning plans at a local level largely cascades down from the key domains laid out in the NHS Outcomes Framework. The challenges manifest themselves in the local variations in care that are widely highlighted as being in need of redress. Once again, these local variations – if intelligently assessed – provide pharmaceutical companies with a powerful market access opportunity. Companies that can demonstrate that their products, not just their messaging, are aligned with local need will significantly increase their chances of uptake.
A good example of how the national agenda is driven by addressing variation in care at local level, is the treatment of diabetes.

Diabetes – a mini case study
The national picture
An estimated 3.8 million people in England have diabetes, with 2.45 million QOF registered patients. This is forecast to rise to 4.6 million by 2030. Diabetes and its complications costs the NHS around 10% of its annual spend. £725 million a year is spent on diabetes medication (8.4% of NHS drugs spend), and an additional £600 million is spent on diabetes-related hospital activity. An estimated 80% of the NHS’s £9.8 billion UK diabetes bill is spent on treating diabetes complications. It is predicted that diabetes will cost the NHS £16.8 billion by 2035.

National and local initiatives
As part of QOF, practices are to be encouraged to provide lifestyle advice and annual glucose checks to everyone judged as high risk from the age of 25 – even those with normal HbA1c levels. NICE is piloting new QOF indicators that promote tight cholesterol control in diabetes.
The introduction of insulin pumps instead of injections, as well as educational programmes such as the DAFNE (Dose Adjustment For Normal Eating) course are good examples of local initiatives to combat diabetes.

Local variation
NHS Hampshire has the highest number of diabetes patients on the QOF register (54, 761). Hospital admissions (inpatient, outpatient and emergency attendances) are costing NHS Hampshire £3.7 million each year – one of the highest of all PCTs. However, its cost per thousand patients is low – ranking 113 of all PCTs. It also has the lowest death rates from diabetes. Therefore, although it has the highest number of diabetes patients, NHS Hampshire appears to be managing its patients well.

NHS Kingston has one of the highest diabetes spend per thousand patients in England. Compared to other PCTs in its SHA, it also has a higher number of Finished Consultant Episodes, longer lengths of stay, higher emergency admissions and the lowest elective admissions. Compared to NHS Hampshire, this suggests  that NHS Kingston could be managing its diabetes patients more optimally.

Lessons for pharma
The diabetes example outlined above provides a clear indication that a one-size-fits-all approach to pharmaceutical sales and marketing will no longer work. The apparent variation in care between two diverse PCTs highlights that every local health economy has different needs. A diabetes KAM working in Hampshire could not relocate to Kingston and challenge stakeholders there in the same way, with the same proposition. The situation, and the opportunity, in each PCT/CCG is totally different. The ensuing approach must be similarly distinct.

A local information strategy is critical for Key Account Managers engaging with today’s NHS. Understanding local dynamics is critical, and the information to facilitate this is increasingly within reach. The key is joining it all together and placing everything in context. It’s a mixture of local and national. Top-down directives issued at national level are providing important indicators by which local commissioners are measured, and are in turn are becoming powerful levers to help pharma develop value propositions that align with local need.

The data is out there. But success is in understanding the difference between information and insight. After all, context is King.

Rhiannon Thomason is Business Development Manager, Cegedim Relationship Management.

England’s public health system has taken several steps towards the transition from PCTs to local government.

Milestones reported by Public Health England (PHE) include an agreed high-level organisation structure, finalisation of plans for transition at local level, and the appointment of a Chief Executive.

The PHE May Bulletin also noted that cancer registration will migrate from the NHS to PHE by April 2013, when the latter becomes a statutory body.

PHE will be responsible for investigating public health, infectious disease outbreaks and the availability and effectiveness of drug treatments.

All PCT plans for the transfer of public health functions to local authorities have now been received and reviewed at SHA cluster level.

The new Chief Executive Designate for PHE is Duncan Selbie (pictured), currently Chief Executive of Brighton & Sussex University Hospitals NHS Trust, who will take up his post in July 2012.

Metrics have been agreed to ensure that the public health system performs consistently during the transition.

Next steps include sharing the full PHE organisation structure with the PCTs; matching roles between the old and new systems; and setting up the PHE board and management team.

Cancer registration is currently undergoing development towards the launch of a new National Cancer Registration Service as part of PHE in April 2013.

This service, according to PHE, “will collect consistent high quality, near real-time data on all the 35,000 cancers diagnosed in England each year”.