This is the final blog in our sexual health commissioning blog series, focusing on the last two stages of the commissioning cycle: ‘doing’ and ‘reviewing’.
Stage 3: Doing – Procuring a service or intervention
The ‘doing’ stage of the commissioning cycle is often about tendering for and procuring a service or intervention from a delivery partner.
I deliberately use the term ‘partner’ here, as I have always considered effective commissioning to be about partnerships, and strong relationships between partners who have the shared aim of improved health outcomes for the population.
Procurement is an area of technical expertise for which we must seek advice from within our own organisations. This blog covers suggestions, which in no way replace the expert opinion you will receive from your procurement colleagues.
Prior to going out to procurement, you may wish to undertake market engagement activities. This supports commissioners in developing the best specification possible for the local population, and can interest providers in the tender.
Procurement colleagues will provide advice on different contracting models and payment mechanisms. If you are part of a wider accountable or integrated care system or devolved administration, the contracting arrangements may be pre-determined. It is important to consider the implications for sexual health, as well as what fits your local circumstances best.
The contracting model will have implications for aspects of the service such as data submissions, clinical governance and training. With a prime contractor model, the prime contractor will usually be responsible for ensuring mandatory data requirements (GUMCAD, CTAD, HIV surveillance, SRHAD) are fulfilled, and for training and clinical governance of sub-contracted services.
Talking to others who have been through a similar process and learning from them is one of the most valuable things we can do. In recognition of this, PHE is working with the English Sexual Health Commissioners Group, to provide a searchable resource of sexual health tendering experiences from across the country. This will allow you to find a relevant example and contact a colleague to find out more.
Stage 4: Reviewing service and intervention success
The review stage of the commissioning cycle covers a number of different activities, from exploring whether the service is doing what you asked; to understanding whether interventions are having the desired effect; and identifying whether the services and interventions are still relevant for your population.
KPIs, audits and service user feedback
Identifying whether the service is doing what you asked it to do relates to contract management processes and measurement against key performance indicators (KPIs).
The national service specification template includes suggested KPIs. It’s important not to overburden providers by requiring them to report against a large number of KPIs, but focus on the important measures. Agreeing a common set of KPIs with others that commission the same provider will reduce the burden on the provider, and allow for comparisons.
There may also be other data that you and the provider agree to review regularly to inform broader conversations about quality, emerging needs, or how local provision needs to adapt and change.
Agreeing a programme of audits with your service provider is also important, taking account of national programmes organised by BASHH, BHIVA, FSRH and the NCSP, and the programme of audits that the provider organisation has planned. Discussion of the results of audits will inform plans for service improvements, and re-audit – the last stage of the audit cycle – allows us to see if the changes that have been implemented have had the desired effect.
In addition to standard contract monitoring meetings, it is valuable for commissioners and providers to meet regularly to review available data on both process and outcome measures. This type of stocktake can take a sector led improvement approach. An example of this approach that has been very well received recently is the chlamydia care pathway workshops that allow all local stakeholders to focus on ensuring the pathway is delivered as effectively and efficiently as possible.
PHE is keen to support commissioners and providers to identify the ‘best way’ to achieve a desired outcome. Evaluating interventions is a key tool to see the impact of the changes made locally, and add to the evidence base that others can draw on.
To this end, PHE is developing a suite of evaluation resources for sexual health, reproductive health and HIV, including an introductory guide, workbook, and menu of output and outcome measures. These resources will be published in the next few months.
Reviewing population need
The final part of the review stage brings us back full circle to ‘analyse’, as it is about reviewing population need to ensure that the services and interventions that were relevant are still relevant given changes in population or epidemiology.
Commissioning is a continuous cycle of assessing population need, and designing interventions to improve outcomes. It requires strong partnerships across the systems between commissioners, providers and the public who are all looking to achieve the same thing – improving patient and population outcomes as efficiently and effectively as possible.
Read our first two blogs on sexual health commissioning here: