Commissioning done right is at the heart of better outcomes and economics for patients and the system, but we are at the beginning of a complex journey, says UK expert.
Not even a few years ago many senior managers in Australia’s healthcare system had not heard of or at least encountered the idea of commissioning, even in primary health networks.
Commissioning is the process of assessing needs, planning and prioritising, purchasing and monitoring health services, to get the best health outcomes. PHNs commission most of the services they put in place and increasingly PHNs will work with hospital networks such as LHDs to co-commission community-based care services to try to make sure their is patient continuity in care treatment.
Even today, while the concept is becoming increasingly central to the way PHNs are run, many hospital networks are either not familiar with the key ideas behind commissioning or, if they are engaging with the concept with their local PHNs, it’s still a second-order problem for most administrators.
That’s understandable, because essentially hospitals don’t commission health services. Some do now co-commission with their PHNs for integrated care services across their region, but this is still fairly rare.
Global commissioning expert Derek Felton, who has worked for many years with the National Health Service in the UK on regional healthcare service commissioning, argues that a proper commissioning framework across a whole healthcare system is the key to unlocking real value for patients and the system.
Mr Felton told today’s 2023 PHN Commissioning Showcase meeting in Newcastle that
hospitals and acute care services need to be more efficient or they will go broke. Everyone realises that the system must shift itself substantively to managing more care in the primary sector.
But to do that the two sides need to integrate their services around patient continuity far more effectively.
“Of the three groups that can drive this process – government, providers or commissioners – it is the commissioners who are in the best position to do it, if it’s done right,” Mr Felton told Health Services Daily.
Despite a long history of commissioning in the UK, Mr Felton said traditional approaches to commissioning in that country were now “not doing near enough to commissioning care for people in a way that works for the individual”.
He said the process in that country had become far too focused on the contract and the money, and in that the journey of the patient had been lost.
“Too many times commissioning organisations glibly put up a slide with a patient in the middle but the actual process of commissioning in a lot of the UK has bypassed that idea for process and money,” he said.
“Although we are commissioning providers, the whole process has to have the patient and their journey as the centre of that process somehow if it is to work.”
Mr Felton said that the fact that commissioning was still young in Australia was probably a good thing because PHNs seemed to be embracing patient stories, lived experiences and actual patient journey’s at the centre of the process as a check that commissioning was doing what it was intended to do – create much better integrated care.
When asked about the power and funding imbalance in Australia between hospital networks and PHNs – a system very different to the NHS and the UK – Mr Felton said he didn’t know enough about that dynamic to make an informed content, but that such an imbalance put even more emphasis on the importance of PHNs getting commissioning right in order to prove the value out to the hospital networks of the process.
“Hospitals will respond if they see the benefits of commissioning, because they have to respond and shift care outwards to the primary care sector more effectively, or they know they will go broke,” he said.
One interesting development Mr Felton described is a new program across the UK around patient discharge summaries.
Mr Felton said where, traditionally, discharge summaries have been written from the acute provider to the primary care and community provider and copied to the patient, now summaries are being written and delivered from the acute provider directly to the patient, and copied to the primary and community care provider.
“In this way, the system is forced to understand the patient perspective first and talk to them in a manner that is patient-centric,” he said.
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