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As the PCTs form clusters from which the Clinical Commissioning Groups will hatch, a new generation of NHS commissioners is being born. Thoreya Swage examines how medtech can help these new customers to redesign services.

Irrespective of the progress of the Health and Social Care Bill currently going through the House of Lords, the momentum of reform of the NHS in England continues to gather pace.

Following a four-month hiatus while the wise and the good of the NHS Future Forum pondered and produced recommendations for the adjustment of the Bill, the Department of Health published further guidance on the developing role of the PCT Clusters. Although the 151 Primary Care Trusts have been squeezed into 51 PCT clusters in preparation for their demise in April 2013, it appears that they have a vital part to play in the development of the emerging Clinical Commissioning Groups (CCGs).

The guidance or ‘shared operating model’ for PCT clusters has been produced by the mandarins at the DH to ensure that the commissioning landscape is as consistent and smooth as possible in time for the takeover by the CCGs. This is to ensure that the nascent NHS Commissioning Board inherits a robust enough system to take charge of further developments and improvements in healthcare in early 2013.

The shared operating model identifies six main functions or ways of working, where consistency of approach is considered to be important. They are listed as commissioning development, financial and operational issues, ensuring quality, emergency planning, development of providers as Foundation Trusts and communications.

CCG commissioning development

The most important function of the PCT clusters is the preparation of CCGs for authorisation as soon as possible following the successful passage of the Health Bill through Parliament. The process of authorisation to become fully-fledged commissioners is due to begin in the second half of 2012. Although this is a year away, CCGs can commence their preparations now using a self-diagnostic tool: an interactive computer-based assessment that helps them to determine their capabilities and identify their development needs. The areas covered include:

• A clear clinical focus for the CCG commissioning plans to include tackling health inequalities and improving primary care.

• Demonstration of meaningful involvement of patients and the wider community.

• A plan for development that is clear and credible and that, in particular, delivers the QIPP (quality, innovation, productivity and prevention) agenda.

• Capacity and capability of the CCG, i.e. robust constitutional and governance arrangements that enable the CCG to commission care effectively and ensure financial control.

• Collaborative arrangements for working with other CCGs, local authorities and the NHS Commissioning Board.

• Capacity and capability of the CCG leadership, which ensures effective working.

The tool helps the CCGs to identify priority development areas, which form the basis of the developmental plan paving the way to full authorisation.

To support all this work, CCGs will receive £2 per head from the PCT clusters, as well as extra management resources to help the groups hone their commissioning skills and capabilities.

CCGs experiencing difficulty in defining their boundaries will have guidance from PCT clusters on how to resolve this. PCT clusters also have the unenviable task of engaging the reluctant practices that so far have not participated in their local CCG discussions, with the aim of making them part of a viable CCG by October this year.

Separation of functions

Through the last quarter of this year, a detailed exercise is being carried out by the PCT clusters to identify and segregate the service areas that CCGs and NHS Commissioning Board will be responsible for.

Although the CCGs will be commissioning acute, mental health, community and ambulance care, other services that PCTs currently commission will need to be transferred to the umbrella of the NHS Commissioning Board:

• GP and other primary care contractor groups (primary care dental, pharmacy and optical services)

• secondary dental care

• prison, specialised and military health services.

Even though the contracts for GP services are held by another body, the CCGs are expected to have an input into primary care development and improvement.

Quality assurance

A vital component of the commissioning process is ensuring the quality of healthcare. Practices may have been involved to a greater or lesser degree in various quality assurance processes in the past; however, CCGs are required to take these responsibilities seriously on board.

There is a whole raft of procedures and measures including delivery of better health outcomes for patients, meeting the Care Quality Commission (CQC) requirements for safety and quality of services, standard contracts, the NHS Operating Framework, professional guidance and other relevant requirements that CCGs need to get to grips with.

This could potentially be a vulnerable time for the development of the CCGs if attention wanders and serious patient safety incidents are not acted on promptly. Clinical governance processes must therefore be extra-secure.

Budgets and responsibilities

Over the next year or so, there will be a period of dual functioning and handover as the CCGs mature and the PCT clusters delegate more and more responsibilities until April 2013. The handing over of the baton has started now, with PCT clusters having identified a ‘clear percentage of budgets’ to CCG pioneers or pathfinders in August and set plans for future delegation of budgets in October.

Sandwiched in between these two was the agreement in September on which mental health and community services will be subject to ‘Any Qualified Provider’ (AQP). This policy is set to be implemented from April 2012, when GPs can refer to providers of certain services eligible for AQP from a list of approved organisations, including private sector companies, drawn up by the DH.

A review of the commissioning support required by CCGs was undertaken in July, with clear arrangements to be agreed by the end of this year.

In March 2012, CCGs will be required to enable the development of the local health and wellbeing boards (the mechanism for joint health and social care planning and local commissioning) supported by their PCT clusters.

Meanwhile, individual PCTs will continue to carry out their statutory functions through the PCT clusters until their abolition in April 2013. The statutory functions include contract monitoring, ensuring that providers meet their QIPP obligations, and other statutory requirements such as safeguarding children and vulnerable adults.

The big challenge for CCGs begins when they are required to lead the next planning round for 2012/13. This will start towards the end of this year, and is a function previously undertaken by the PCTs. It involves doing a needs analysis, identifying local inequalities, understanding demand and resources for local services, negotiating and setting priorities with partners, and developing a local strategic vision. Handover of commissioning functions will continue, with CCGs being an active participant in the subsequent contract negotiations and agreements.

How medtech fits in

It is apparent that despite the pause for reflection on the proposed changes in the English health service earlier this year, the momentum of dissolving and restructuring healthcare organisations continues. The picture remains a little confusing, however, as CCGs are in varying stages of development and maturity and it is not clear that all are now truly viable although the October deadline has passed.

What is clear is that that the work of commissioning and delivering healthcare has to go on, and now is a good time to find out who the key movers are within the CCGs. At this point the developmental needs of CCGs are uppermost, and it is here that medtech companies can provide some input. Skills and knowledge in leadership development and highlighting evidence-based medical technologies that really make a difference are two key areas of potential input.

CCGs will be keen to redesign services in order to make patient pathways across primary and secondary care more consistent and to move more care into the community setting. It is here that telehealth and telecare will come into their own as a means to facilitate the transition.

Demonstrating the effectiveness of home monitoring of blood pressure, supporting community services such as HIV or stoma care, and promoting medical devices that offer continuous subcutaneous infusion of insulin are examples of technology implementation where a vital case can be made to these prospective healthcare commissioners. CCGs will also look favourably on management of their patients in the surgery with video links to consultants for advice, rather than sending them to outpatient services.

Clinical services that utilise new or different medical technologies will require staff who are appropriately trained and have the skills and competencies to use the equipment. This training can be provided by the medtech industry.

As ever, good information forms the basis of good commissioning and the demonstration of successful patient outcomes. Data systems in the community setting have always lagged behind their counterparts in the acute setting. Given that CCGS will need to develop services in the community, new and better IT systems will be required.

Get ready!

The next few months will be busy while the NHS sorts itself out at a structural level. Once the picture begins to clear, the medtech industry will need to engage with the new clinically skilled commissioners who now have the financial responsibility for making decisions about healthcare.

Dr Thoreya Swage was formerly an NHS clinician and a senior manager in various NHS organisations covering acute and primary care. She has expertise in commissioning health services and is currently working for a number of NHS organisations, including DH agencies, to develop a more commercial approach to the commissioning of healthcare.

John Wilkinson (pictured), Chief Executive of Eucomed, has received a special Career award from the International Vascular and Endovascular Course (IVEC) in Milan.

The award recognises the medtech industry’s contribution to the development of vascular and endovascular surgery.

IVEC Chairman Giorgio Biasi presented the award to John Wilkinson to “honour the excellence of a distinguished scientist and eminent colleague who has contributed enormously in promoting, divulging and spreading culture, development and achievements in the field of vascular and endovascular techniques.”

Following the award presentation, Wilkinson gave the Edmondo Malan Lecture on ‘Development and Achievements in Endovascular Procedures as a Result of a Continuous and Ingenious Co-operation between Physicians and Industry’.

He discussed the long history of collaborative working between clinicians and industry over 200 years, with ideas from doctors and surgeons being developed by companies, culminating in such revolutionary devices as the drug-eluting stent.

Wilkinson also emphasised the need for innovation to be built on a platform of ethical interaction and transparency, and for industry to support education and training in the delivery of new therapies.

Finally, he drew attention to the demographic and economic challenges facing Europe’s health systems, and called for a collaborative approach between all stakeholders to support innovative solutions to these urgent problems.

Eucomed is the leading European medical technology industry association. It represents 4,500 designers, manufacturers and suppliers of medical technologies.

European medtech industry association Eucomed will launch a conference pre-vetting system in early 2012 to assess all third-party educational conferences and congresses sponsored by its members.

The new system is the first of its kind in the healthcare industry, because its assessments will be binding.

The independent Eucomed Compliance Panel will assess educational events for compliance with the association’s Code of Ethical Business Practice in relation to such factors as scientific content, location and venue.

Each outcome will be made publicly available via a dedicated website, and relevant stakeholders will be notified.

The Eucomed Code allows member companies to sponsor third-party educational events such as medical congresses, seminars and training courses, subject to restrictions. Until now, members had to establish their compliance independently. The new system will apply a uniform compliance determination process to all Eucomed members.

“The conference pre-vetting system is a unique initiative in the healthcare sector,” said John McLoughlin, Chairman of the Compliance Panel. “It will be supervised solely by our Panel, which is a completely independent body. Eucomed members are required to follow the assessments.

“If a conference receives a negative assessment, Eucomed members may not sponsor either the conference or individual healthcare professionals who wish to attend the conference.”

John Wilkinson, Eucomed’s Chief Executive, added that the new system “is not only necessary for our members in their day-to-day activities but is also key to increasing the consistency and transparency of industry behaviour.”

Eucomed intends to give key stakeholders an opportunity to comment on the assessment criteria.

The pre-vetting system will begin as a pilot and be reviewed 6–12 months after its launch. It will be the sole responsibility of the Compliance Panel.

Eucomed represents 22,500 designers, manufacturers and suppliers of medical technologies in Europe.

The medtech industry must focus on meeting the cost-efficiency and health outcome needs of health systems through a value-based innovation strategy, according to a new report from industry association Eucomed.

The European medical technology industry association launched its five-year industry strategy report ‘Contract for a Healthy Future’ at the MedTech Forum in Brussels, outlining the industry’s role in guiding healthcare systems towards a sustainable future.

Eucomed called on the medtech industry to change its business model and mindset, but also called on healthcare payers and policy-makers to embrace the concept of value-based innovation.

A report from the Economist Intelligence Unit (EIU), sponsored by Eucomed, opened the MedTech Forum. ‘Future-proofing Western Europe’s healthcare’ examined how healthcare systems need to change in order to square the circle of growing demand and tighter budgets.

The EIU report argued that Europe’s healthcare systems need to become more efficient, effective, integrated and informed. The medtech industry can support these developments with evidence-based technologies – providing not just the technologies but the evidence base to support their implementation.

The Eucomed report emphasised that the medtech industry needs to change and will deliver and demonstrate solutions to meet the cost-efficiency and health outcome needs of payers and policymakers in order to ensure sustainable, accessible healthcare and healthy ageing for the population.

However, Eucomed emphasised, other healthcare stakeholders must also reconsider their role: for value-based innovation to have full impact, policy-makers must develop better cost models and abandon silo-based budgeting, while payers must prioritise value – in terms of productivity and efficiency – rather than price.

“We have to rethink our healthcare systems in Europe and steer them back onto a sustainable path,” said Eucomed Chairman Guy Lebeau (pictured below). “As an industry, innovation has always been at the heart of what we do. But the future will demand a different kind of innovative thinking from all stakeholders in our economies. We will take the first step and deliver value-based innovations that deliver a demonstrable positive return on investment in healthy life years for citizens.”

John Wilkinson, Chief Executive of Eucomed, added: “It is short-sighted to cut back on medical technologies when health budgets are squeezed, especially when you consider that 70% of health spending is consumed by personnel and hospital organisation. Compare that with medical technology which accounts for less than 5%.

“If the industry delivers its promise and enables healthcare systems to become more productive and efficient, governments should reward us and invest in the right technologies.”

More information on these ideas can be found on a dedicated website, Reforming Healthcare in Europe, launched by Eucomed.

Eucomed represents 22,500 designers, manufacturers and suppliers of medical technologies. SMEs make up more than 80% of this sector.

Guy Lebeau

The only solution to the NHS funding crisis is “radically re-orienting services to reduce hospital stays and offering new forms of care,” according to NHS Confederation head Mike Farrar (pictured).

Farrar, a long-term supporter of medtech innovation as a facilitator of NHS service redesign, has said in a Guardian article that shifting healthcare services into the community and centralising surgery provision is the only way to avoid wholesale loss of NHS service provision.

He noted that the imperative of achieving £20 billion of savings by 2015 was already increasing NHS waiting times and raising the threat of the health service cutting services to “salami slice its way out of financial trouble”.

Farrar also said that there was a danger of the NHS reducing access to “less effective treatments”, though in fact this is already taking place in most Trusts.

To avoid financial disaster on the one hand or disastrous loss of services on the other, he argued, the only way forward is to shift the focus of services into the community – and immediately to cash in on the benefits of service redesign by closing down much of the existing in-patient hospital provision.

Surgery can be relocated to major centres and out-patient services to primary and home-based care, he said, with hospitals ceasing to be the main providers of secondary care.

Farrar’s argument echoes the emphasis of Lord Darzi’s NHS Review (2008), but with the crucial further twist of a serious funding crisis.

His stark message is that without this reconfiguration of services – which will only be possible if funding is made available for service redesign – healthcare in the UK “faces a bleak future”.

The medtech industry has argued for years that the use of new technologies to shift more diagnosis, monitoring and treatment into the community is essential to the future of the NHS. Now, a leading NHS figure has said there is no other option.