Commissioning the service
The commissioning landscape in England changed dramatically with the creation of Clinical Commissioning Groups (CCGs) and Clinical Reference Groups (under NHS England). Northern Ireland, Scotland and Wales retained their current commissioning structures.
CCGs are effectively consortia of GPs within a geographical patch. They can ‘buy in’ commissioning support from either the Commissioning Support Units or the independent sector. NHS England (formerly the NHS Commissioning Board) is responsible for commissioning specialist services and also directly commissioning general practice. The CCGs are responsible for commissioning everything else based on their ‘intimate knowledge’ of their population and their clinical priorities. CCGs cannot commission Primary Care as that would mean commissioning from themselves.
NHSE Clinical Reference Group
Where this gets interesting for intensive care is that both organisations commission the service. NHS England commission intensive care where it forms part of another specialised service such as Major Trauma, and Vascular Surgery; CCGs commission the rest. The Manual of Specialist services detail which service is Specialist and which is not.
Intensive Care Medicine has a Clinical Reference Group (CRG) which resides in the Trauma Programme of Care.
FICM is one of the affiliated organisations to the CRG.
The Service Specification and GPICS
To date the main work of our CRG has been to produce a service specification (formally D16, now likely to be D05 after a rearrangement of CRGs), for the intensive care element of clinical services commissioned by NHS England’s Specialist Commissioning teams.
This service specification sits as an appendix to all other service specifications which NHS England commission and detail the clinical standards for Intensive Care Medicine (ICM), the components of a National Dashboard, the initiatives proposed for Commissioning Quality (CQUIN) and Productivity (QIPP) and the co-location relationships for services which work alongside ICM. This is currently with NHS England for discussion.
The Service Specification is underpinned by the standards of GPICS.
Care Quality Commission
We worked closely with the Care Quality Commission to build GPICS’ standards into the Care Quality Commission critical care assessment tool. This is now in routine use. Although much of the above is focussed on England, we hope that the experience here can be helpful across the UK.