A framework for Commissioning with NICE Guidance & related Quality Standards

1). To develop a co-ordinated approach to the identification, monitoring and implementation of the full range of NICE guidance and associated quality standards.
2). To offer a refreshed approach to the commissioning cycle which supports the consistent commissioning of evidence based services.
3). To provide assurance to the CCG governing bodies that all national guidance for best practice is considered before making recommendations for approval.
4). To provide a systematic approach to business planning, horizon scanning and commissioning for quality, complementary to local needs and plans.
5). To bring together core business components which support the CCG to make high quality evidence based decisions which optimise impact.

As newly established organisations, North Lincolnshire Clinical Commissioning Group and North Yorkshire Humber Commissioning Support Unit wanted to ensure that they adopted a systematic approach to commissioning high quality evidence based services for the population of North Lincolnshire.

Commissioning care in line with NICE quality standards and guidance should enable commissioners to be confident that the services they are commissioning are cost-effective and focussed on driving up quality. Therefore, it was decided that the CCG and CSU, supported by NICE, would benefit from developing a framework that ensured NICE guidance and quality standards were central to commissioning activities.

A workshop was organised and consisted of representatives from the CCG, CSU and NICE. Commissioning dementia services was identified as a strategic priority for the CCG and, therefore, to bring the discussions to life, the workshop focussed upon the NICE quality standards and implementation resources for dementia and how they might be incorporated into a commissioning framework.

A draft framework was developed as a result of the discussions, ensuring that it was complementary to, and integrated with, other CSU business planning frameworks and CCG commissioning approaches.

The following actions were agreed.
1). Review the local dementia strategy and service specifications against NICE quality standards.
2). Review the NICE Support for Commissioners of Dementia Care document and to populate the commissioning tool.
3). The learning, from focussing upon NICE guidance, quality standards and implementation resources for dementia care, will inform the full implementation of the framework that considers all NICE guidance and quality standards.
4). The impact of implementing the framework will be reviewed within 12 months of implementation.
5). An approach called 'Experience Led Commissioning' was used to guide local interpretation of the NICE Quality Standards and involved key stakeholders, including patients, carers, wider community and partners in North Lincolnshire.
The flowchart in the supporting material provides an example of how the framework was used to ensure that the quality statements within the NICE Quality Standards for Dementia (Quality Standard 1 and Quality Standard 30) were interpreted locally and incorporated into the Dementia Strategy and action plan for North Lincolnshire CCG.

When developing the framework, the following key enablers were identified:
1). Ensure that senior sponsorship from the CSU and CCG is in place from initiation of a piece of work.

2). Ensure that the CSU and CCG work closely together to both agree roles and responsibilities and ensure that the impact of implementation and learning is co-ordinated and reviewed. In North Lincolnshire we established a small working group to oversee delivery and secure on-going commitment to progress any agreed actions.

3). In relation to the use of the Commissioning tool: dementia care:
- ensure that the user has access to the necessary data and that it is both accurate and available; this would ensure that the results after applying the tool are informative. For example, the data captured by the Acute Trust as 'admissions' did not clearly identify the specific origin of the patient, such as a care home or community residential placement.
- As a result of using the commissioning tool, it was recommended that a request be made, via the forthcoming contracting round, for admissions data to be coded to ensure that the origin of the patient can be accurately determined.