Integration of Adult Health and Social Care in Scotland: Consultation on Proposals

Chapter 7 Professionally led locality planning and commissioning of services

7.1. A central role for professionals in the planning and commissioning process is critical to the success of putting in place integrated pathways of care that focus in particular on preventative and anticipatory intervention. For the purposes of the reforms we propose here, we are using "commissioning" to mean the activities involved in assessing and forecasting needs, agreeing desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place.¹²

"The [Scottish Government's] plans for bringing health and social care together mean that major changes lie ahead for these services. The self-directed support legislation should give people greater choice and control over their care packages. However, if these changes are to work well, it is essential that councils and health boards improve the planning and commissioning of services."
Robert Black, Auditor General for Scotland, 1 March 2012¹³

7.2. We recognise the importance and potential benefits of strong clinical and professional leadership in local decision making. A criticism of some Community Health Partnerships has been the lack of perceived opportunity for professionals - including GPs, acute clinicians, social workers, nurses, Allied Health Professionals, pharmacists and others - to take an active role in, and provide leadership for, local planning of service provision. These proposals therefore include a requirement for Health and Social Care Partnerships to put in place arrangements to address this.

7.3. In particular, these proposals reflect our belief that some aspects of planning for service delivery can operate more effectively and efficiently at a layer of organisation that lies between the Health and Social Care Partnership governance Committee and individual practitioners. This is the level at which greater localism can improve outcomes for patients and service users, and at which economies of scale, and better strategic oversight, can be achieved beyond that which is available at the level of, for example, the individual GP practice.

7.4. In broad terms, we expect locality planning arrangements to deliver locally agreed strategic commissioning plans that have the support of the professionals and other care providers who will deliver services. These local plans will then form a key input to the production of the Partnership's joint strategic commissioning plan.

7.5. Effective locality planning can only take place with the full participation of the range of professionals involved in the care of patients and service users along the patient pathway, in acute care and in the community, along with managerial staff of the Health and Social Care Partnership. It will also be important to ensure the direct involvement of local elected members, representatives of the third and independent sectors, and carers' and patients' representatives.

7.6. There are already examples of such professionally-led localism making a difference in Scotland, in particular in NHS Highland and NHS Grampian. These proposals are intended neither to stifle activity that is already underway, nor to be directive about mechanisms for locality planning that all areas should adopt. The nature of the challenge means that different local solutions will work in different localities. These arrangements must involve the full spectrum of professionals from health, social care and partners from the third and independent sectors.

7.7. We plan to work with key representative groups to build upon the experience gained to date, from within both NHS Scotland and Local Authorities, from current examples and more generally from our previous experience of locality working in Community Health Partnerships, Community Planning Partnerships and Local Healthcare Co-operatives. We will act to remove barriers that may in the past have prevented sustainable, worthwhile engagement between statutory partners (Health Boards and Local Authorities) and clinicians. We will need to ensure that locality planning groups have the right level of delegated authority, including influence over locality shares of the integrated budget, to make decisions that impact on local service provision.

How will this approach be different from current arrangements?

7.8. Community Health Partnerships (CHPs) have been criticised in some areas by GPs and other professionals for limiting their opportunities to play an active role in local service planning and provision. There has also been frustration that some CHPs were 'toothless', with decisions regularly having to be pushed upwards to the parent Health Board and with little influence in particular over acute budgets. These proposals will address those concerns, by requiring locality planning arrangements be developed and implemented in Health and Social Care Partnerships.

How will we go about achieving this change - what will change in legislation?

7.9. We will place a duty on Health Boards and Local Authorities to consult local professionals, across extended multi-disciplinary health and social care teams and the third and independent sectors, on how best to put in place local arrangements for planning service provision, at the level between Partnerships and individual GP practices. Having consulted, Partnerships will be required to put in place, and to subsequently support, review and maintain, such arrangements.

7.10. Beyond legislative change, we will also work with our partners in the NHS, local government and the professional organisations to agree the "landscape changes", such as workforce development and leadership development, that will be needed to ensure that professionals can participate effectively in locality planning as a driver for change in an integrated system of health and social care.

7.11. In terms of GP engagement, we anticipate the need to consider workload issues, and therefore availability of time to participate in locality planning, particularly in areas of high deprivation; and recruitment and retention of GPs, particularly in areas with the poorest health outcomes. We have already begun a dialogue on the scope of the GMS Contract in Scotland, and we will continue to use that opportunity to consider how to give practical effect to these proposals for locality planning.

7.12. As with every aspect of these proposals, leadership is key. We will use our ongoing development of a leadership programme for primary care practitioners to support improvement. We will also work with stakeholders, and all relevant professions, to develop guidance to support effective development and implementation of locality planning arrangements that meet local requirements.

What do we want to know from you?

Question 15: Should the Scottish Government direct how locality planning is taken forward or leave this to local determination?

Question 16: It is proposed that a duty should be placed upon Health and Social Care Partnerships to consult local professionals, including GPs, on how best to put in place local arrangements for planning service provision, and then implement, review and maintain such arrangements. Is this duty strong enough?

Question 17: What practical steps/changes would help to enable clinicians and social care professionals to get involved with and drive planning at local level?

Question 18: Should locality planning be organised around clusters of GP practices? If not, how do you think this could be better organised?

Question 19: How much responsibility and decision making should be devolved from Health and Social Care Partnerships to locality planning groups?

Question 20: Should localities be organised around a given size of local population - e.g., of between 15,000 - 25,000 people, or some other range? If so, what size would you suggest?