Putting it into practice: planning and commissioning

Determining what services and support are needed to enable people to self-manage, and securing funding for those activities, can come from a variety of points within a local health economy. These include clinical commissioning groups (CCGs), Health Boards (in Scotland) and provider organisations, as well as national bodies.

The starting point to plan and commission self-management support is working collaboratively with people with long-term health conditions to understand the outcomes that are important to them and how these can best be achieved.

Outcomes-based commissioning has an emphasis on moving away from a system that focuses on payment for activity and instead focuses on commissioning outcomes that are meaningful to local people. When this is applied to commissioning self-management support, clinical outcomes are understood as contributory to the outcomes that are important to people – such as maintaining independence by staying active or in work. People generally need both clinical and non-clinical support to manage the different aspects of their conditions to achieve these broader outcomes. In practice, many outcomes-based commissioned contracts have relevant process measures, such as the number of people referred to a self-management programme or having a care plan.

There is no single approach to deciding what support to provide and how, but there are key components that could be considered.

  • Specific self-management support services – these may be clinical or non-clinical services focusing on enabling people with long-term health conditions to self-manage. Examples include health coaching and structured group education programmes for people with long-term health conditions and their carers, or online programmes.
  • Wider services – these recognise that people need support on an ongoing basis to maintain their skills and confidence to self-manage and to manage the wider social and lifestyle aspects of their health. Examples include services based in the voluntary and community sector such as walking groups and condition-specific peer support groups.
  • Planning organisational processes – to facilitate services to work in a person-centred way. Examples include IT systems that ensure ‘informational continuity’ across a range of providers or enable telephone or Skype consultations, and a system-wide agreed care plan template.
  • Providing training for workforces – to ensure people working in health care (from clinical professionals to non-clinical coaches or support workers) have the knowledge, skills and confidence needed to support people to self-manage.

There are a number of commissioning strategies that could be used to encourage providers to deliver self-management support. English commissioning levers include, for example, Commissioning for Quality and Innovation (CQUIN) payments, which enable commissioners to pay providers for local improvement initiatives. There are also national CQUINs that align with self-management support. Other English examples include the Quality Outcomes Framework (QOF), Better Together fund, and ‘direct enhanced’ GP services.

To commission on an outcomes basis, performance management and measurement systems would have a focus on evidence of outcomes as well as activity and costs. Tracking these kinds of outcomes is a new way of working for the NHS, and many outcomes-based commissioning schemes are having to set up new data collection systems to track progress.

Further reading

Thanks for the Petunias. Year of Care.

A guide to developing and commissioning non-traditional providers to support the self-management of people with long-term conditions www.diabetes.org.uk/upload/Professionals/Year%20of%20Care/thanks-for-the-petunias.pdf

Need to nurture: outcomes-based commissioning in the NHS. Health Foundation

Paper detailing the current shape of outcomes based commissioning in England www.health.org.uk/sites/default/files/NeedToNurture_1.pdf

Patients In Control: Commissioning to support self-management of long-term conditions. South East NHS Commissioning Support Unit

Details stages of commissioning, and key questions to ask at each stage http://participation.southeastcsu.nhs.uk/wp-content/uploads/2015/01/Commissioning-to-support-self-management.pdf

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