Viewpoint - 'Buyer beware' should be CCG policy

GP commissioners need acute provider contracts that pay for outcomes achieved. By Paul Corrigan

Paul Corrigan: contracts must also provide for accountability (Photograph: JH Lancy)
Paul Corrigan: contracts must also provide for accountability (Photograph: JH Lancy)

I have commented before on how the new GP commissioning leaders in their own practices are used to contracts that ensure the money you pay to a service provider secures the outcomes you want to buy.

Many GP commissioning leaders have been shocked to learn the NHS standard contract does not hold acute providers to account. They need new forms of contract to commission care from providers.

Some clinical commissioning group (CCG) leaders have developed (and I played a small part in this) a form of contract called a capitated outcome-based incentivised contract (COBIC). These contracts require commissioners and providers to focus on and define outcomes that really matter to patients and are value for money.

A COBIC pays for those outcomes, rather than processes or medical activity that may or may not improve health, and the only way to achieve better outcomes is to require closer integration of primary, acute and social care.

The COBIC needs to start to develop healthcare provision with a specific category of patient in mind. It could be based on a health matter, such as musculoskeletal services, or a population group, such as children or the frail elderly.

Providers must collaborate
Each COBIC budget is based on an understanding of the needs of that population and would include financial rewards for achieving specified outcome measures. To deliver those outcomes and make the efficiency savings necessary to stay within the allocated budget, providers of poorly co-ordinated care must collaborate to provide more integrated care.

Most people now recognise it is time to improve the outcomes people receive from health services. Too often, healthcare is not as good as it should be and we are not using the best evidence to commission or provide services.

Unlike previous attempts to change this, the COBIC offers a step change in the scale of incentives offered. This would start with at least 5% of the contract offered to be specifically about outcomes and would grow every year.

An incentive of this size focuses providers' attention on outcomes and value, and allows clinicians and other staff to use their expert knowledge to innovate and improve care.

The idea of contracting for outcomes is important in its own right, but it is also important because any day now, the government is going to start a process of developing an NHS that drives towards healthcare outcomes. Then contracts achieving this goal will become important.

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