Speaking at the Commissioning 2012 event in Kensington, London, Cumbria CCG chairman Dr Hugh Reeve said some CCGs were using efficiency savings generated by practices to fund enhanced services and other schemes that offered practices a chance to earn more.
He added that his CCG would look to keep most commissioning functions that relied on local knowledge 'in-house', and only outsource generic functions relating to areas such as IT, human resources and financial management.
Cumbria CCG is formed of six locality groups which feed into a central CCG hub. The localities are responsible for commissioning and running services within their own areas, Dr Reeve said.
In order to keep locality practices incentivised, Dr Reeve said the CCG would reward them financially for good behaviour.
‘This final point, which I think is the direction of where things are going to go, is how do you incentivise groups of practices together?
‘You get a group of practices together and say to them: "Here’s your budget for referral management, and if you receive some savings within that together, you can keep that together.". But it’s not on an individual basis, it’s on a locality basis.'
Dr Reeve added: ‘Tower Hamlets have done some really impressive work on this around their long-term conditions management. They’ve incentivised their practices with QOF plus.
'So they said to practices: "If you hit targets for diabetes, for example, we will give you an additional payment – a local enhanced services payment. But it’s not to individual practices, it’s to this cluster of practices, so you all have to achieve it together."
'You can image the discussions between the practices: "If you lot don’t sort this out I’m going to lose five grand."
'And that sort of thing does focus people's minds in a way that perhaps it hasn’t done before.’
Dr Reeve also revealed his CCG’s plans for commissioning support. He said the CCG would keep as much local specific work in-house as it could, but other services would be delegated to companies.
‘We’re actually outsourcing our medicines management support because although that requires local knowledge and relationships with practices, I see a real benefit for that working on a wider footprint than just Cumbria,' Dr Reeve added.
However, he said the bulk of services that would be outsourced would cover functions such as financial support, human resources and information management – collecting and collating data.