World Class Commissioning is a developing discipline with information at its heart. Daloni Carlisle reports.

When the Department of Health was developing World Class Commissioning in 2006-7, there was an argument about whether information management should be among the competencies needed by primary care trusts to deliver the ‘patient-led NHS’.

Derek Felton, managing director for Tribal Health Commissioning, recalls the debate. “We pushed very hard to have [a] competency on information management, as we felt it was not done justice in the competency framework,” he says.

In the event, the argument was lost and information management was wrapped up into Competency Five, which examines how well PCTs manage knowledge and conduct regular assessments of current and future health needs.

However, it is seen by the NHS Information Centre and others as the competency that underpins all the others. And today, Felton is quite comfortable with the outcome. “Everybody is in agreement [with the competencies as they are] and there are good reasons why information management was not included,” he says.

Information matters

No-one should mistake the lack of an explicit competency on information management as an indication that IT and data analysis are not crucial to delivering World Class Commissioning.

“It’s a big lever at the moment,” says Graham James, vice president of CACI. “PCTs are starting to look at IT solutions to help them to achieve their targets and improve commissioning and thereby patient care.”

That’s borne out by the three PCTs to obtain Level 3 in last year’s WCC competency assurance measurement by the DH. Each is using innovative IT solutions to deliver real change.

For example, NHS Milton Keynes has developed a health observatory jointly with its local council, which is delivering rich information on everything from crime levels to smoking, right down to ward level, and allowing health and social care to track changes in the population and plan services.

NHS Nottingham City is using sophisticated benchmarking and market segmentation techniques to pinpoint the cohorts it needs to target on health issues such as smoking, sexually transmitted diseases and cardiovascular disease.

Rotherham PCT, meanwhile, is using disease-specific comparative benchmarking tools to help discussions with GPs about clinical practice.

More such good practice case studies are set to be shared at a conference organised by the NHS Information Centre on September 9 2009 in Leeds. These will be published later on the IC’s website.

Quality assurance: round two

A week later, on 16 September, the DH will launch the next round of quality assurance. PCTs are acutely aware of this – and the need to show progress on meeting the competencies.

Last year, only three PCTs scored Level 3 – short of the highest Level 4 – on Competency Five. Another 109 scored Level 2 and 41 were at Level 1 – the starting blocks. There is, says the DH, room for improvement.

The NHS IC has been very clear that PCTs’ fundamental approach needs to change. It is no longer good enough to get information from the Secondary Uses Service and Health Episode Statistics and assume they tell you everything you need to know about outcomes, quality and need.

The DH and NHS IC are both actively working on providing new metrics and giving PCTs access to an ever wider range of data and tools.

For example, the DH and NHS IC are jointly to launch new data packs on 16 September that will include new metrics, new benchmarking tools and new dashboard tools.

PCTs will be able to compare their performance not just locally, regionally and nationally but also with peer groups that they select themselves. They will be able to create dashboards of their least and most improved areas.

James says: “We are seeing a debate starting in PCTs,” he says. “Traditional Business Intelligence tools tend to look at the numbers and how we can slice and dice them. Now, PCTs are looking for an evidence base.

“They need to buy improved services for a population, so they want to know what are the outcomes and where are the weaknesses? They are focusing on quality rather than on costs and contracts and we are starting to see it pulling commissioners and providers of services closer.”

New ways of consulting

This is changing the way CACI works with PCTs, James adds. Rather than coming in to a health economy with an IT solution to a problem, his teams are now working with consultants who specialise in change management in the NHS.

“We are bringing in associates who can work with commissioners on how to measure quality, how to plan forward, and then looking at the information they need to get there. It is bringing a new subtlety to the way we work.”

Felton agrees, although as a wider consultancy his teams already bring in not just the IT specialists but the health analysts and organisational change specialists.

“We tend to work on three year contracts with PCTs delivering transformational change,” he says. “The PCTs we work with understand the importance of information management, and, in most places it is not high tech clever systems, it is the expertise of data analysts and health economists that makes the difference.”

Nevertheless, some PCTs are deploying clever tools – and getting clever results too. NHS Ashton Leigh and Wigan is currently deploying the Johns Hopkins Adjusted Clinical Groups Case Mix System.

This is a clinical system that supports predictive modelling and risk profiling. Felton says: “It is a clinically driven tool that we are using to equip practice based commissioners to look at the case mix, their resource usage and predicted usage and ultimately to allocate budgets and manage performance.”

NHS Rotherham, meanwhile, it working with its acute and community providers and local council to implement McKesson’s InterQual a clinical appropriateness of care tool that is already helping the provider tackle delayed discharges and will ultimately give the PCT the evidence on which to base service redesigns.

Clever or simple, the IT-based exploitation of data to improve commissioning and therefore patient services while also delivering efficiencies in an ever colder financial climate is an area ripe for development.

What is World Class Commissioning?

Commissioning has always been the Achilles heel of the NHS’ purchaser-provider split. The DH says the World Class Commissioning programme will change things, by encouraging a more “strategic” approach that is “focused on health outcomes”.

World Class Commissioning grew out of the ‘Commissioning a Patient-Led NHS’ paper in 2005, which envisaged a split between the commissioning and providing functions of PCTs. A painful PCT reorganisation was followed by an assessment of their ‘fitness for purpose’ by the DH, which highlighted considerable gaps in their capabilities to carry out commissioning.

Mark Britnell, a high-flying NHS manager, was brought in to develop a framework. This was launched in 2007 as World Class Commissioning.

There are four key elements to the programme; a ‘vision’, a set of competencies, an assurance system and a support and development framework. The DH published its first round of assurance assessments last year and is now working on ‘year two’, which it says will take account of “the very different financial climate in which we need to operate.”

A final division between PCT commissioning and providing was achieved this spring, when PCTs hived service management off into provider arms and other management vehicles. Mark Britnell left for KPMG in June.

Meantime, the House of Commons Health Select Committee has launched an inquiry to determine whether the World Class Commissioning programme is likely to deliver the stronger PCTs and improved planning and purchasing promised.



The Department of Health has a section of its website devoted to World Class Commissioning.

There is also an NHS support and development site for world class commissioners.

The NHS IC WCC datapacks are now available for testing. 


This article was originally published as part of E-health Insider’s Special Report, Information for World Class Commissioning.