Any qualified provider - Is that you or your service?

Published: 16 September 2011

The Department of Health is extending patient choice of provider. Liz Bonner reports.

Incontinence is highly prevalent in the general population but under diagnosed and under treated. Poor continence care can lead to unnecessary catheterisation and associated urinary tract infections which are a major cause of care home and hospital admissions. Continence services cost the NHS £112 million in 2009/10. The Royal College of Physicians audit 2010 reported:

•  clinical outcomes and quality of care needed drastic improvement in most areas
•  a lack of response to patient’s views and needs
•  a lack of expertise in commissioning
•  a lack of integrated care commissioning a good quality integrated continence service will help to improve quality, dignity, experience, safety and lead to reduced health and social care costs.

The Department of Health (DH, 2011) is extending patient choice of provider, which means when a patient is referred (usually by their GP) for a particular service, they should be able to choose from a list of qualified providers who meet NHS service quality requirements, prices and normal contractual obligations

Key principles.

• Any qualified providers qualify and register to provide services via an assurance process that tests provider’s fitness to offer NHS-funded services.
• commissioners set local pathways and referral protocols which providers must accept.
• Referring clinicians offer patients a choice of qualified providers for the service being referred to.
• Competition is based on quality not price. Providers are paid a fixed price determined by a national or local tariff.

Implementation

There will be phased implementation. There will be a transitional year in 2012-2013.

The DH has prioritised:

• musculo-skeletal services for neck and back pain
• adult hearing services in the community
• continence services (adults and children)
• diagnostic tests
• wheelchair services (children)
• podiatry
• venous leg ulcer and wound healing
• primary care psychological therapies for adults.

PCT clusters supported by pathfinder clinical commissioning groups are tasked to select three or more services for implementation in 2012/13,. They may choose other services which are higher local priorities. There is a huge emphasis on patient involvement and making real choices available.

The DH will establish a national qualification process, across all services, to minimise bureaucracy and reduce transaction costs for providers and commissioners. For example, all providers will have to be registered with the Care Quality Commission or registered with a body leading the qualification process for a given service, as well as be licensed by Monitor (from 2013) or meet equivalent requirements.

Providers will be listed in a directory so that patients and GP’s know who is providing what services where.

What is happening now?

Strategic health authorities have identified lead PCT clusters to develop an implementation pack – consisting of service specifications and tariffs for each service on the national list. The specifications will have regard to NICE quality standards or alternative accredited evidenced based practice. This will be complete by November 2011.

Who is influencing the process for continence?

Royal College of Physicians
ACA
RCN

Paediatric Continence Forum
Promocon
ERIC
International Continence Society

What are the strengths of this process?

• There is a real commitment to improve patient services.
• It will be the first time that there has been a national template for a service specification that is built upon the firm foundation of the patient/carer views.
• We all know that service users know about continence and how it affects the day to day organisation of their lives.

Specifications will be based on evidence, such as:

• NICE 2010  Paediatrics Commissioning Guide: paediatric continence services
• All Party Parliamentary Group (APPG) 2011 Cost effective commissioning for continence care Are there any weaknesses?

Inequality

We know that there is inequality of access to paediatric continence advisers, specialist continence advisers, and provision of product. Very few areas in England have truly integrated services with pathways of care from primary to secondary and tertiary care.Will some areas loose and others gain? Will the clusters be able to fund evidenced based services? Watch this space.

Liz Bonner
MSc BSc (Hons) Public Health Nurse D.N cert RN
Lead Nurse Bladder Bowel service Haringey
Whittington Health
Liz.bonner@haringey.nhs.uk