Transforming Community Services

The best practice guidance document ‘Transforming Community Services: enabling new patterns of provision’ (TCS programme) issued by the Department of Health (DH) in January 2009, provides clear direction and a transitional agenda for fundamental reforms in the way in which Primary Care Trusts (PCTs) are to organise, manage and improve the planning and delivery of health care services to the public. Additional TCS best-practice guidance was issued in June 2009, with further guidance proposed.

The founding principles of this service redesign are based on an underlying drive for improvement in quality (and consistency) across all aspects of care delivery at strategic, tactical and operational levels. It sets out how PCTs – and the infrastructures and service partners they operate with - need to complete their transformation into separate but co-ordinated management and business units. Whilst likely to remain within a single legal entity one ‘arm’ of the PCT or Foundation Trusts (FT) will act and operate as the Commissioners of health care – i.e. establishing what services are needed and how best to procure them from potential suppliers; and the other as a Provider of health services. Each will work and consult closely with Practitioners (GPs) and the General Public about the health needs and service provisions.

Whilst the document suggests a number of different organisational forms / operating models may arise to match the demand and supply requirements to suit local conditions and markets, the emphasis of the reforms are aimed at improving health care outcomes and patient experiences; consideration is also given to how some of the key input factors, such as the buildings, equipment and resources (health estate and facilities) can be streamlined and used more effectively to derive better value. The TCS programme classifies health estate and facilities (including IT systems & equipment) as ‘Infrastructure’.

To make these reforms work, there is an explicit responsibility placed upon the PCTs to gather and maintain operational intelligence (i.e. data and performance metrics) about the Infrastructure requirements, and to demonstrate and transparently inform their cost effectiveness, affordability, availability and (best) value attributes to match the supply criteria to demand characteristics. The TCS paper also suggests that the Commissioning arm of the PCT should typically take lead responsibility for the management of the infrastructure elements, not least from a financial perspective, as it allows Providers, both from within the PCT and from others within the local healthcare economy (LHE), to be more flexible and competitive in their delivery and pricing models.

The guidance acknowledges that where PCTs do not possess the requisite Infrastructure management expertise (internally), or would prefer to procure such expertise (externally), it should be able to do so through existing or new Strategic Partnership arrangements. In many cases PCTs may be able to call upon their LIFT Companies to do this, where such expertise / capability may already exist. Alternatively PCTs may form commercial alliances in Strategic Estates Development models (SED) through which it could obtain its entire estate (and infrastructure) planning, development and management requirements. For the PCTs and within the local healthcare economy generally, there are a number of Customer groups for whom the service needs, provisions and improvements are paramount:

The local Communities (the Public) – i.e. the patients, and the population healthcare needs – including education and prevention as well as treatment
Practitioners (GPs)
Commissioners of health care
Providers of health services – including other / neighbouring Trusts and private sector partners
The Local Authorities and social / support services
Strategic Health Authorities
The Department of Health (policy and target setting)

Each of these possess different – and sometimes potentially conflicting – needs, however current healthcare reforms including the TCS programme are instilling a common set of objectives for all. These are based around improving the quality of care and how quality (and consistency) is measured and rewarded. New emphasis is being centred on:

Patient Pathways (i.e. the journey a Patient takes from discovery of condition, through treatment, to completed and satisfactory outcome)
Models of Care (i.e. finding / trying new ways of treating Patients illnesses)
Patient Experiences (i.e. what the Patient thinks of the quality of treatment and service)
Outcomes (i.e. the effectiveness of the above in treating and preventing unhealthy conditions and improving the health and well-being of the local community – and of the Nation)
Value for Money and (sustainable) Affordability

For more information :

Department of Health – Publication – Transforming Community Services

Community Health Partnerships – Publications relating to Transforming Community Services