1 January 2013

How NICE Can Help Clinical Commissioning Groups Deliver High Quality Care

It's been a busy time of late for Clinical Commissioning Groups (CCGs) as they embark upon the first wave of the authorisation process required to transform them into statutory bodies.

At the same time, CCGs are working hard to ensure that they are ready to meet the clinical challenges that lie ahead from April 2013, and are drawing up detailed plans and agreements between commissioners and trusts.

At NICE we've been working for some time on how we can align our guidance, advice and standards so that they can really help CCGs to successfully deliver clinical and cost effective services for the patients that they serve.

Quality standards

The 2012 Health and Social Care Act set out a new role for NICE in producing quality standards for health and social care.How NICE Can Help Clinical Commissioning Groups Deliver High Quality Care

Whereas a clinical guideline provides a comprehensive description of an entire care pathway, NICE quality standards provide up to a dozen sentinel markers which are statements of what high quality care and services will look like in that setting.

The really distinctive feature of the NICE quality standards is that they provide you with measures to enable you to see how your service matches up to the standard.

So far, we have published 22 quality standards including a number of primary care topics like diabetes, dementia, chronic kidney disease and COPD.

Over the next 5 years we will produce a library of 180 standards which will touch on most aspects of care provided by the NHS.

We hope that the standards will help people to design and commission high quality, evidence based services for their patients and population. The intention is that the quality standards of today will become the essential standards of tomorrow.

NICE quality standards will feed into the Clinical Commissioning Group Outcomes Indicator Set (CCGOIS) that the NHS Commissioning Board has developed.

This was formally known as the Commissioning Outcomes Framework (COF) but the NHS Commissioning Board has changed the title to avoid confusion with the NHS Outcomes Framework and make it clear that the indicators relate to outcomes of commissioned services, not commissioning itself.

The primary aim of the CCGOIS is to support and enable clinical CCGs to plan for health improvement by providing information for measuring and benchmarking outcomes of services commissioned by CCGs.

The CCGOIS will aim to drive local improvements in quality and outcomes for patients. It will hold CCGs to account for their progress in delivering these outcomes, and provide clear, publicly available information on the quality of healthcare services commissioned by CCGs.

NICE's role is to develop some of the indicators for the CCGOIS based on quality standards, and to quality assure CCGOIS indicators from other sources. An independent advisory committee has been established to lead on this work.

Together, quality standards and the CCGOIS will provide CCGs with really powerful tools to improve quality and outcomes for their populations.

Supporting you

To help CCGs get the most from our quality standards we have produced a ‘Support for Commissioners' tool for every quality standard that we have published.

The support tool can help CCGs to:

  • consider the cost of making the changes needed to achieve the quality standard at a local level
  • identify where cost savings can be made
  • highlight the areas within the quality standard with that have the biggest implications for commissioners

These tools will be really useful to CCGs in helping you not only put together a really effective process for handling guidance from NICE but also as a way of ensuring that the evidence based recommendations we make are embedded in day-to-day practice.

On top of the support we provide for our quality standards we have a suite of other resources to help you get the most out of our guidance and standards.

We have published over 40 Guides for Commissioners. These are more detailed than our Support for Commissioners, and help you to consider the key outcomes and service-related issues when commissioning services in line with NICE guidance and standards.

Each guide also has example service models and ideas for using QIPP and CQUIN to deliver service improvement. Every guide contains a commissioning and benchmarking tool, which is a resource that you can use to estimate the level of service needed locally, as well as the cost of local commissioning decisions.

One of the most important aspects of working with our guidance is knowing what's coming round the corner. Being able to look at drafts of the guidance and anticipate its publication allows you to get ahead of the game and start to prepare to put the recommendations into practice.

Our online Forward Planner shows you all the guidance we are developing and gives you an idea of its likely resource implications. It's an Excel spreadsheet, so you can use all the usual functions in excel to sort and filter it so you can focus in on the areas that are really important to you. We know that getting your financial planning right is a big help to putting the guidance in place and the Forward Planner can make a big difference with this.

Another good way to keep up to date with the latest primary care developments from NICE is to sign up for our free monthly e-newsletter - Update for Primary Care.

Managing budgets

Understanding the resource implications of new NICE guidance is really important. When we publish guidance we produce an analysis of the likely cost impact and this is accompanied by a tool that helps you to work out the implications for your population. We're currently working to make sure that these use the new CCG populations so that they're right up to date.

We know that everyone is focused on making sure that we get the best value from NHS spending and we've got a contribution to make to that as well.

We've been through all the guidance we've produced over the last few years and pulled together all the recommendations we've made about things that you can stop doing and put them in an easily searchable database. These are interventions with a weak or non existent evidence base and help you when you're reviewing your services to identify some easy wins.

We've done the same for recommendations we've made about referral and intervention thresholds. The two resources are known respectively as our ‘do not do' and referral advice databases. They're really straightforward to search to find the areas that you're interested in.

When it comes to writing a clear and credible QIPP plan you may find the QIPP Collection on NHS Evidence a useful tool.

The QIPP Collection is a growing database of case studies, including ones on medicines management, that show how health professionals are improving quality and productivity across the NHS.

The collection is unique in that the case studies it hosts have all been quality assured. The examples are evaluated based on quality improvements, savings, evidence and implementation and are peer reviewed.

An evidence summary provides you with at-a-glance details of how these elements have been rated within each case study.

But it's not all about cash and making savings! NICE guidance plays a really important role in ensuring that health professionals are keeping their own professional practice up to date.

We've worked with BMJ Learning to develop some really popular web-based education tools that let you work through a series of learning exercises and then do a test to demonstrate how you've improved your knowledge.

You can then print out a certificate for your professional portfolio. In effect this is free continuing professional development, which is great when training money is tight.

NICE Pathways

You may feel at this point completely overwhelmed by all the different pieces of guidance, standards and products that NICE produces, and this can make it difficult when searching for a particular recommendation or support tool.

To help with this we've developed NICE Pathways which brings together - for the first time - all related NICE guidance and associated products in a set of interactive topic-based flowcharts.

It is a visual and interactive format that provides a way to quickly view and navigate guidance, including quality standards, and other tools from NICE on a given topic.

Previously, there has been no easy way to see at a glance everything NICE has said on a specific condition across all its separate published guidance.

NICE Pathways covers the entire range of NICE guidance, including health technology appraisals, clinical guidelines, public health and social care advice, quality standards and implementation tools.

Pathways can be viewed on smart phones and tablets allowing easy access while on the move. Users are also able to print out the Pathways and save them for future reference.

This new resource will greatly facilitate access to NICE guidance for commissioners, who need to commission care across a whole pathway.

Users do not need to understand how NICE classifies different types of guidance to view everything NICE has said on a particular topic. NICE Pathways will synthesise all of this guidance together in one place.

Share your views

Having access to these web based resources is great, but sometimes it's useful to be able to talk to someone about the approach that you are taking in your CCG to work with NICE guidance.

We can help with that. We have a team of 8 Implementation consultants regionally based in England and Northern Ireland. The team is really keen to build links with CCGs and to help you use NICE guidance, advice and standards to improve services for your population and patients.

Our field team can help you to develop a process for working with NICE quality standards, share examples of good practice from other CCGs and even run workshops for your CCG introducing all the support available from NICE. If there's something that you think the field team can help you with, please do drop them a line at fieldteam@nice.org.uk

And why not come along to the NICE Annual Conference 14-15 May 2013 - which will include a dedicated stream for primary care - to learn more about how NICE can support CCGs.