On 1 April 2009, UnitedHealth UK assumed responsibility for commissioning £107m of acute and specialised services with 17 London Providers. Contract budgets ranged from £684k at Wandsworth PCT to over £23m at The Royal Brompton.

This contract represents a unique public and private sector partnership under the Department of Health’s Framework for External Support to Commissioning (FESC). It is unique in the number of organisations and stakeholders involved in the partnership and in the complexities of the commissioning arrangements. UnitedHealth UK works on behalf of the South Central Specialised Commissioning Group (SCSCG) and the nine South Central PCTs to deliver this contract.

• Delivered £3.4m savings against forecast outturn
• Embedded a number of data challenge tools that have not only enhanced the quality of Trust data submissions but have also disputed over £25m of activity and achieved savings of over £1.3m direct through a specified monthly challenge process
• Established collaborative and enduring relationships with London Trusts
• Enforced contractual requirements requiring, for example, London Trusts to provide data as stipulated in their contractual agreements.
• Developed and implemented a Provider Directory which details the specialised services and their costs at each of the London Trusts, enabling far more transparency with charging and information to support decision-making
• Developed generic modelling approaches to forecast bone marrow transplants, neurology and neonatal services on a one and five year basis
• Issued progressive commissioning intentions for 2010/11 including reductions in readmissions, prior approval processes, and thresholds for high cost drugs
• Brought together previously disparate commissioners, the London Sector Acute Commissioning Units and other Specialised Commissioning Groups (SCGs) in an Out of London (OOL) collaborative commissioner’s forum.

Our priority in 2010/11 is to implement five cost improvement strategies. These include local price reviews and a series of audits to manage and deliver against a £10m commissioning gap and additional growth and cost pressures.

One particularly exciting and innovative cost improvement plan is to improve inpatient efficiency management. Two of our nurses will be embedded within two Trusts and used in a joint nursing/leadership role to manage pathways, support the management of discharge into the community and prevent readmissions where possible. This will make savings to the local health economy by reducing excess bed day costs and readmission rates.

Additionally, In 2010/11 we will be managing the contracts we have secured with the London Acute Commissioning Units, the London SCG and outer London SCGs. We have implemented a strong performance management process and will be moving to a London-based team who will further develop the day-to-day relationships with the Trusts.

In addition to our South Central-wide performance reporting, we will develop PCT-specific monthly reporting and liaison with each of the nine South Central PCTs. We will also report on quality metrics which capture outcomes and patient and carer-experience as part of the routine monitoring. It is important that the individual reasons for referral routes are understood and strategic decisions taken about future service planning.

Despite the challenge of managing increasing demand within finite and increasingly constrained resources this remains an exciting and innovative programme underpinned by a high performing team of clinical, analytic and management experts.