Addressing the ‘postcode lottery’ in local resource allocation decisions: a framework for clinical commissioning groups

Russell, Jill; Greenhalgh, Trisha; Lewis, Harriet; MacKenzie, I.Z.; Maskrey, Neal; Montgomery, Jonathan; O’Donnell, Claire

doi:10.1177/0141076813479192

Cited by 18 publications

(18 citation statements)

References 5 publications

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“…A national framework (Competency Framework) was a useful tool used by some CCGs to help them make complex resource allocation decisions;28 29 such an approach was considered ‘best practice’. This is a process where two or more CCGs work together to commission the same service for which they are jointly responsible; this allows a sharing of risk and transfer of skills and support.…”

Section: Resultsmentioning

confidence: 99%

“…They preferred knowledge exchange which is fast and flexible, for example, conversations and patient stories, rather than research papers;34 ‘working on the ground’ involved the gathering of evidence to determine how local service provision is improving patients' lives 25. This experiential knowledge and local evidence played a key role in improving the quality of judgements in decision-making 28. In handling complex situations, commissioners rarely accessed explicit evidence from research but instead relied on internalised guidelines, or ‘Mindlines’ built on training, experience, interactions, local circumstances and collective views of colleagues on how things should be done 34.…”

Section: Resultsmentioning

confidence: 99%

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Commissioning care for people with dementia at the end of life: a mixed-methods study

et al. 2016

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ObjectivesTo understand how end-of-life (EoL) care for people with dementia is currently commissioned (ie, contracted) and organised, with a view to informing the development of commissioning guidance for good-quality community-based EoL care in dementia.DesignMixed-methods study; narrative review and qualitative interviews.Setting8 National Health Service (NHS) clinical commissioning groups (CCGs) and five adult services across England.MethodsNarrative review of evidence; 20 semistructured interviews (telephone and face-to-face) with professionals involved in commissioning EoL care for people with dementia.Main outcome measuresSummary of the existing evidence base for commissioning, commissioners' approaches to the commissioning process for EoL care for people with dementia in England.Results:In the context of commissioning EoL for people with dementia, the literature review generated three key themes: (1) importance of joint commissioning; (2) lack of clarity for the process and (3) factors influencing commissioning. In exploring health professionals' perceptions of the commissioning process, ‘uncertainty’ was elicited as an overarching theme across the CCGs interviewed. Organisation of the process, lack of expertise, issues surrounding integration and the art of specification were considered important factors that contribute to the uncertainty surrounding the commissioning process.ConclusionsThe current evidence base for commissioning EoL care is limited with considerable uncertainty as how clinical commissioners in England undertake the process to ensure future services are evidence-based.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Commissioning care for people with dementia at the end of life: a mixed-methods study

et al. 2016

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“…Skills are especially important in the securing or contracting domain for procurement, risk and contract management (Figueras et al 2005). Local commissioners and providers need to have the competency for local decision management (Russell et al 2013). This includes priority setting, engagement of the population and stakeholders, quantifying, costing, structuring demand and ensuring services are effective and high quality.…”

Section: Discussionmentioning

confidence: 99%

A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy

Gardner

Davies

Edwards

et al. 2016

Aust. J. Prim. Health

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Abstract. The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning.

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“…The five centres in the south of England used differing preventative and scoliosis management interventions in this review, which highlights variation in practice between services. This “post-code lottery” of UK health service provision is commonly referred to in the literature [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes

Matthews¹,

Blandford

Marsden

et al. 2016

Scoliosis

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BackgroundTo date the main treatment approach for neuropathic onset scoliosis has utilised thoracic lumbar sacral orthoses (TLSO) to stabilize the spine and enable stable sitting. Dynamic elastomeric fabric orthoses (DEFOs) may achieve both of these aims if used as an early intervention. Due to a lack of evidence in this area, a retrospective audit of case notes was undertaken to understand current orthotic practice investigating the usage, outcomes and clinical characteristics of treated children with neuropathic onset scoliosis. Clinical notes of 180 children at risk for, or identified with, scoliosis were audited using a search matrix to identify diagnostic group, spinal muscle tone, Gross Motor Functional Classification Scale (GMFCS) level, orthotic treatment modalities, scoliosis specific data, surgical interventions, adaptive technologies used, and outcome measurements reported.ResultsOf the 180 notes examined, 85 were male; mean age nine years one month [SD four years seven months]. Spinal muscle tone was reported in 137 cases: 122/137 presented as low tone, 4/137 high tone, 6/137 fluctuating tone and 5/137 typical tone. Scoliosis was confirmed in (77/180) of whom (39/77) used a DEFO. Another (43/180) had a spinal curve developing, of whom (22/43) used a DEFO. The remaining (60/180) had no report of spinal curvature, but used a DEFO as a preventative measure. GMFCS scores were reported for 49 children of whom 14/49 were graded as level 4 and 17/49 level 5. Of the children with scoliosis who had spinal curve shapes reported, 48/60 had a C-shape presentation and 12/60 had an S-shape.ConclusionsThe findings confirm previously reported papers in children with neuropathic onset scoliosis in relation to curve shape and GMFCS levels. It provides some evidence of the role DEFOs may have in the management of these children, and highlights the need for further research in this area due to the lack of peer-reviewed publications.

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Addressing the ‘postcode lottery’ in local resource allocation decisions: a framework for clinical commissioning groups

Cited by 18 publications

References 5 publications

Commissioning care for people with dementia at the end of life: a mixed-methods study

Commissioning care for people with dementia at the end of life: a mixed-methods study

A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes

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