Who Commissions What?
The Provider Selection Regime (PSR), a cornerstone of the Health and Care Act 2022, was introduced to overhaul how healthcare services are procured in England. Coming into effect on 1 January 2024, the PSR is designed to streamline and improve the process, ensuring that service provision aligns more closely with patient needs and system efficiencies. This section aims to demystify the PSR, offering a concise overview of its purpose, scope, and the processes involved in provider selection, culminating in an analysis of what this regime means for healthcare providers.
At its heart, the PSR embodies a commitment to flexibility, collaboration, and patient-centred care within the procurement of healthcare services. By setting out clear guidelines for 'relevant authorities'—which include NHS England, Integrated Care Boards (ICBs), NHS trusts and foundation trusts, as well as local and combined authorities—the regime delineates a new path forward.
Provider Selection Processes
The PSR introduces three primary pathways for the selection of service providers:
Direct Award Processes (A, B, and C):
Where an existing provider is the sole option for delivering services.
Patient choice prevails, without restrictions on provider numbers by the authority.
The current provider meets contract standards and significant contract changes are not anticipated.
Most Suitable Provider Process: This process allows for a contract to be awarded without competition, based on the authority's identification of the most fitting provider.
Competitive Process: A traditional competitive approach to contract awarding, fostering a level playing field among potential providers.
These processes are designed to ensure transparency and accountability, necessitating thorough documentation and public disclosure of decision-making criteria and outcomes.
Implications for Providers
For healthcare providers, the PSR represents both an opportunity and a call to adapt. The emphasis on flexibility and the potential for direct award processes mean that providers who have established themselves as reliable, patient-focused, and capable of meeting contract standards may find paths to service provision less encumbered by traditional procurement barriers. However, this also means that providers must be more proactive in demonstrating their value, aligning with the overarching goals of patient care excellence, and engaging in collaborative practices.
Providers should be particularly attentive to the strategic implications of the PSR:
Navigating New Pathways: Understanding the nuances of direct award and most suitable provider processes could be key to securing contracts.
Demonstrating Value: Beyond competitive pricing, providers need to articulate their unique contributions to patient care and system efficiency.
Collaboration: The regime's emphasis on system-wide collaboration suggests that providers should seek partnerships and integrative approaches to service delivery.
In conclusion, the PSR is a transformative framework poised to reshape how healthcare services are procured and provided in England. For providers, it presents a dual challenge of adapting to new procurement processes while maintaining an unwavering focus on patient-centred care. Success in this new landscape will require a keen understanding of the PSR's mechanisms, strategic positioning, and a commitment to innovation and excellence in healthcare delivery.
Integrated Care Boards (ICBs) and Integrated Care Systems (ICSs)
ICBs have now assumed statutory responsibility for commissioning the majority of NHS services, absorbing some direct commissioning functions previously managed by NHS England. This transition is significant, with the bulk of NHS England’s budget now allocated to ICBs to commission services tailored to their local populations.
ICBs, in collaboration with NHS trusts and foundation trusts, are tasked with creating a comprehensive five-year plan detailing the delivery of NHS services to meet the needs of their communities. Despite the delegation of certain functions to place-based partnerships, ICBs retain formal accountability for NHS expenditure and performance within their systems. This new structure aims to foster a more collaborative environment, facilitated by the new provider selection regime, enhancing the relationship between providers, local authorities, and other stakeholders.
Local Authorities
Local authorities play a pivotal role in commissioning publicly funded social care services, including in-home care and residential care services. Since 2013, they have also been responsible for commissioning a variety of public health services, such as sexual health services, health visitors, school nursing, and addiction services. Their involvement is crucial in addressing the broader determinants of health and wellbeing, making them integral to the ICS ecosystem.
NHS England
NHS England maintains its strategic oversight role within the NHS, directly commissioning certain specialised services, including treatments for rare conditions and neonatal services. While some of these responsibilities are increasingly shared with ICBs, NHS England also commissions essential public health services known as Section 7A services, including immunisation and screening programmes. Most of NHS England's commissioning functions are executed through its regional teams, which assure the quality of ICBs' commissioning through annual assessments. This assurance role is crucial, especially as ICBs take on primary care commissioning responsibilities.
Commissioning Support Organisations
Commissioning support units (CSUs) offer crucial support for commissioning activities across the health system, serving ICSs, local authorities, hospitals, and NHS England. Despite variations in their use, CSUs provide analytical, transformational, and back-office support, among other services, responding to both local health system needs and national priorities.
Conclusion
In concluision, it's clear that this legislative shift is more than just procedural; it is a change aimed at fostering a more patient-centric, efficient, and collaborative healthcare procurement and delivery system in England. As we step into a new era, marked by the implementation of the PSR, healthcare providers are presented with both challenges and opportunities. To navigate this transformed landscape successfully, providers must embrace adaptability, strategic innovation, and a deepened commitment to patient care. This means not only understanding the intricacies of the new selection processes but also demonstrating unmatched value in their service offerings and forging stronger, more integrative partnerships within healthcare systems.