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How will Sustainability and Transformation Plans (STPs) change the NHS commissioning landscape?

Sue Thomas and Paul Midgley, of Wilmington Healthcare, take a look at new commissioning structures and what they mean for pharma
The official roll-out of Sustainability and Transformation Plans (STPs) in April will herald the dawn of a new era for NHS commissioning as the old divisions between primary and secondary care are finally swept away.  

Key changes will include a reduction in the number of commissioners. For example, the Birmingham and Solihull STP plans to merge its three CCGs; while Lancashire and South Cumbria propose a single health and well-being board.  

There will be new roles for the remaining CCGs, which will be empowered to commission services across the entire care pathway – from diagnosis through to end of life care – following new co-commissioning arrangements with NHS England.

Each of the 44 STPs will adopt a different approach to commissioning services, based on local needs and conditions. NHS England's strategic framework for specialised services has called for an area-by-area approach, and a move away from the 'binary' system where services were either nationally or locally commissioned.
 

Wilmington Healthcare has been following the progress of all the 44 STPs in great detail, via its tracker system for the past six months. Pharma needs to drill down into the individual footprints in a similar level of detail in order to get to grips with STPs’ priorities and objectives, both top line and therapeutic, and obtain budgetary information and population statistics. It also needs to find out information, such as the burden of diseases in individual areas, and the key specialists.


To clarify its approach, pharma needs to think about the service now:
 

1.   
Which provider incurs the cost of delivering the service?

2.    What are all the inputs currently required to deliver the service, including staff, premises, materials, medicines, training and travel?
3.    Which commissioner currently pays for the service and what type of contract and tariff is used?
4.    What is currently charged to the commissioner for buying the service?  

Pharma also needs to think about the service of the future:
       
Which provider will incur the future costs of delivering the service? As well as looking at how costs are going to change, think about who will incur these costs. 

What model is the provider working to – e.g. are they an Accountable Care Organisation (ACO) working on an outcomes-based contract built up from a capitated budget?

Which commissioners will pay for the new service and what will be charged to them? What will be the difference for commissioners after the service change?

Are there other consequences of a service change in terms of costs incurred to the NHS?  For example, might your product reduce hospital admissions – is it given less frequently than competitors, or orally instead of by infusion?  

Can the provider realise these savings through their model e.g. an ACO will look at system wide costs and may see an investment in drug prescribing as an opportunity to change the pathway of care to a more cost-effective community based service.
   

Pharma needs to understand how new patient pathways will work in the individual STPs, from diagnosis to death, and define how its products will fit into those pathways and really make a difference. To achieve this, it will need versatile customer-facing teams who are comfortable working with a variety of stakeholders, many of whom they may have had limited or no contact with in the past – such as local authorities, charities and patient groups – as well as clinicians across a wide spectrum of NHS services and particularly in CCGs and new much larger provider ACOs.  

                                                                                            Ends  

Sue Thomas is CEO of the Commissioning Excellence Directorate and Paul Midgley is director of NHS insight, both at Wilmington Healthcare. For information on Wilmington Healthcare, log on to
www.wilmingtonhealthcare.com

23rd March 2017

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