Healthy London > Resources > Case study: Developing pan London commissioning policies

Case study: Developing pan London commissioning policies

Bringing together partners with clinicians and Londoners is one of the key roles Healthy London Partnership plays in tackling London’s most complex health challenges. Through clinically-led partnership working across London’s Sustainability and Transformation partnerships (STPs) and NHS England (London region), Healthy London Partnership has played an important part in the development of pan London commissioning policies.

What was the challenge?

In December 2017, London’s Clinical Commissioning Groups (CCG) commissioned a series of expert working groups to harmonise clinical commissioning policies for eight specific treatments.  The aim of the work was to ensure that Londoners have equal access to specific treatments across London, to make sure that the treatments are used consistently across London and according to criteria that will result in improvements to the health of patients.  The programme was set up and adopted the title London Choosing Wisely.

The programme aimed to build on the large volume of work which had already been undertaken by individual CCGs and STPs. The eight treatments reviewed by the London Choosing Wisely programme were the surgical removal of benign skin lesions; hip arthroplasty; knee arthroplasty; knee arthroscopy; interventional treatments for back pain; varicose vein procedures; shoulder decompression and cataract surgery.

What did we do?

The programme was clinically-led by a London Choosing Wisely Steering Group, chaired by Dr Vin Diwakar, Medical Director for NHS England (London region), and we provided specialist programme management in order to establish the processes and extensive stakeholder engagement required for the development of pan London policies.

We established the programme’s Task and Finish Groups which steered the review process for each treatment area. Each group comprised of clinical commissioners, GPs, hospital and public health consultants, Royal Colleges and professional societies, representatives of patients and the public and allied health professions.

Working at pace, we organised and managed the six Task and Finish Groups across a total of 12 meetings during spring 2018. This brought together numerous clinical experts and patient representatives from across London to consider the latest available clinical evidence, discuss how this and current practice should shape a London policy, and review their recommendations against an ethical framework.

As each policy was developed a ‘sense check’ and feedback phase was introduced into the programme and managed by Healthy London Partnership. This phase of the programme allowed the Task and Finish Group to get wider input from interested parties, including clinicians, professional bodies, Healthwatch and patient groups. We undertook the detailed analysis from each of the eight ‘sense check’ phases for the Task and Finish Groups and the Steering Group.

Linked to this, a comprehensive Communications and Engagement Plan for the programme was developed and managed by Healthy London Partnership. This guided the extensive liaison with key partners and stakeholders at the appropriate stages of the programme – including but not limited to those in the NHS, with patients and patients groups, for example London’s Healthwatch organisations, and with many other interested parties, including media organisations.

Earlier this year, NHS England launched a consultation into commissioning policies nationally which included some of the treatment areas also under review by the London programme. Healthy London Partnership reviewed the national consultation and proposals on behalf of the programme against the work which had already been carried out in London. Presenting this detailed analysis to the London Choosing Wisely Steering Group, we then submitted a formal response to NHS England to ensure that the key learnings and views of the London programme were included in the national consultation.

What were the results?

In October 2018, the London Choosing Wisely Steering Group signed off all eight pan London commissioning policies which were developed through the expert clinical working groups. These policies have now been presented to London’s CCGs.

The programme is a strong demonstration of clinically-led partnership working across London’s STP areas. Working at pace to bring together so many clinical and public health experts from across London was a huge achievement.

Undertaking such an extensive review at a regional level positions London as a leader in delivering appropriate, consistent and robust policies for providing equal access to certain treatments where there has previously been variation. Additionally, all doctors across London will have the latest evidence on what treatments should be offered to patients to achieve the best health outcome, whilst also seeking to ensure that patients do not receive unnecessary treatment or intervention that will have little impact on their condition.

CCGs will now consider how far the draft pan London policies presented vary from existing local policies, where these are present.  The programme itself was advisory, with the statutory duty for approval of London-wide policies resting with each CCG governing body who have the opportunity to further review, engage and consult, where appropriate, before making a decision on implementation. 

Find out more

For more information about the programme, visit the dedicated London Choosing Wisely section of www.healthylondon.org or contact Healthy London Partnership.

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