Commissioning care planning – the nuts and bolts including currencies and tariffs

Read more in Chapter 14 (PDF 1MB) and Appendix 5 (PDF 1.1MB)  - which describes the local LES (Local enhanced service) arrangements in the pilot sites

Commissioning is the foundation of the house model and ensures that the changes in organisation (practice and clinic level) and the training and support services are available.  The principles by which a single practice, group of practices or a wider community can begin to embed routine care planning for people with long term conditions (LTC) is describes in the RCGP Report: ‘Care planning – improving the lives of people with LTCs.’

Each of the Year of Care Pilot sites commissioned care planning via a local enhanced service (LES) (PDF 1.1MB) which were all different but had some generic and specific elements

The issues of currencies and tariffs for people with LTCs differ according to whether they were purchasing service from

• Specialist services including in patients
• Traditional community services
• Basic routine care from primary care
• Services to support self management form non traditional community providers

This led pilot site to make the following key points

• The potential of developing packages of care, tailored quality incentives and performance monitoring to facilitate more effective commissioning of personalised care is only just beginning to be explored
• Currencies for LTCs need to be local rather than national because of the complexity of service provision and the different strategic objectives which commissioners will wish to incentivise.  They may include elements reflecting the complexity of care and  quality markers as well as periods of time
• Currencies for Non Traditional Providers are more complex and would benefit from having components for quality, incentivising good practice including sustaining behaviour change.