The government has warned the NHS that it will need to save at least £20 billion over the next four years to cope with rising demand and technological change.
It’s white paper, ‘Equity and excellence: Liberating the NHS’ also proposes to shake up the health service, passing 80% of its funding to GP commissioning consortia, and putting a new focus on provider choice.
Taken together, these changes will put a renewed focus on getting the best out of the data that the NHS holds.
Dr Shane Gordon, GP commissioning lead for NHS East of England, and chief executive of the multi-award winning Colchester Practice based Commissioning Group, says information is going to be the key to the success or failure of GP commissioning.
“To do any better we need to look at the world in a slightly different way and join up the high level commissioning data with low level patient data – then we can start to see the patient journey and where there is waste in the system,” he says.
Information for commissioning
David Stout, director of the NHS Confederation’s Primary Care Trust Network, says commissioners have always needed access to good data.
However, the health service has often struggled with data quality and with turning raw data into useful information. The previous government’s World Class Commissioning programme had information elements, and Stout feels that it helped to improve the information available.
Yet he adds: “There is still a fair way to go in most places. I would say we have reasonably good acute data, reasonably good general practice data, moderately good mental health data and pretty poor community services data.”
Joining up data is also a challenge for the health service. Dr Gordon says his experience has shown that it can be done – but only by using sheer manpower. Such labour intensive data crunching will be impossible for consortia likely to be running on a third of the management funding of primary care trusts.
The obvious answer is IT and Dr Gordon believes technology solutions will be the way ahead – although he says the systems he wants are not yet available off the shelf.
It is clear that every GP consortium will need IT to tell it how much it is spending, what it is spending it on and what outcomes that is delivering. So information commissioning solutions for GP consortia must cover a huge range of areas, including acute activity, capacity planning, pathway modelling, clinician level resource utilisation and predictive case finding.
Ed Kenny, district manager, public sector, at global information technology company EMC, argues that another key change between the early days of commissioning and now is that strong communication links have been put in place between the different parts of the NHS, backed by the N3 network.
However he adds: “What we don’t want is 500 consortia with 500 different information management systems – that would be ludicrous. With cloud services, you don’t have to manage the IT but can just buy what you need on a pay as you go basis.”
For providers and patients
EMC works with 35% of NHS trusts reports that it is seeing an increasing appetite from hospital IT directors and senior managers for IT solutions to help them manage rapidly growing volumes of data and to use that data to deliver better services at lower costs.
The white paper sets out plans for a big injection of competition into the provider market, with patients given more choice of treatment and the right to use “any willing provider.” Stout says this means hospitals will have an incentive to collect more meaningful activity data; and to improve its quality. GP commissioning consortia will become more demanding customers and increase the level of challenge about inaccuracies.
He adds: “The information revolution and drive to put information in public domain will also encourage providers to ensure data is accurate.”
Who will do the work?
Dr Charles Alessi, a GP in Kingston and executive member of the National Association of Primary Care, argues that until now the NHS commissioning function has not been sufficiently robust about the need for accurate data.
“With lots of block contracts in place, nobody cared less whether the data was accurate or not,” he contends. However, Dr Alessi does not expect every GP to become a data specialist. Like many, he predicts that contracting functions may be outsourced.
The expertise that has been built up within PCTs will also need to be harnessed; and the British Medical Association has urged the forming consortia to look to the NHS for support where possible. Despite this, Stout warns expertise could go to the private sector – and the price could go up as a result.
James Lennon, head of the public sector at consultancy CACI, believes that applying a pure outsource model will not work in the NHS. He is concerned about what is going to happen to GP consortia that go over budget; with commissioning support organisations waiting in the wings.
He also sees 500 consortia consolidating into a much smaller number of bodies to handle the challenge of managing information and commissioning. But once the dust settles, he says those bodies will need to start using data to look forward, rather than using historical data as the basis for buying decisions.
“Commissioners will need to look at how their population’s needs are going to change in the future and what are the unmet needs in the community,” he says. “You can then target your social marketing messages effectively and find out where the efficiencies are in the process.”
Lennon says CACI is taking IT tools used in the marketing world to help commissioners do this. The need to shift attention towards keeping patients well was also identified by the King’s Fund and the Nuffield Trust in ‘Where Next for Commissioning in the NHS in England?’, published earlier this year.
The two health policy think-tanks argued that the capacity of commissioners to analyse data and information was an area of particular concern and that there needed to be a “huge advance” by commissioners in the exploitation of patient-level information on costs, quality and service use.
Judith Smith, head of policy at the Nuffield Trust, says World Class Commissioning got bogged down in assessment and assurance but fears that successive NHS reorganisations are holding back attempts to address the NHS’s capacity and expertise to make sense of its data.
She adds: “Having that capacity will continue to be a significant challenge for the health service and will quickly be a challenge for GP consortia.”
Coping with uncertainty
Dr Gordon and colleagues in NHS East of England are about to set the ball rolling on that challenge with a series of technical workshops for GP commissioners to help them make an assessment of their information needs.
“We have invited all the major industry players and the GP commissioners and the plan is to stand back and take a look at what we have got now and do a bit of gap analysis.”
Repeating that process nationwide is likely to be a task facing all GP consortia over the next few months, as everyone waits for more details about how the reorganised NHS will work.
This article first appeared as part of the eHealth Insider special report on information for commissioning.