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5-minute guide to...managing performance

The final article in our eight-part guide on the basics of PBC, produced by Michelle Webster and Beverley Slater of the Improvement Foundation

The final article in our eight-part guide on the basics of PBC, produced by Michelle Webster and Beverley Slater of the Improvement Foundation

Official definition

The World Class Commissioning competency ‘Manage the local health system' is addressed at PCT commissioners and looks at their ability to:

• monitor provider financial performance, and activity and sustainability in accordance with contractual agreements

• use provider performance evaluation findings to lead regular and constructive performance conversations with providers and work with them to resolve issues

• understand the motivations of current providers and foster an environment of shared responsibility and developments

• act to terminate contracts when necessary.

Put into layman's terms

Commissioners making sure they are getting what they pay for.

What it involves

As practice-based commissioners do not hold contracts directly with providers, they have a limited direct role in managing the performance of commissioned services. Roles and responsibilities set out in Guidance on the NHS contract for acute hospital services, Department of Health, December 2008, specify that performance management is the responsibility of the PCT as it is the ‘co-ordinating commissioner'.

Practice-based commissioners are involved in developing the care pathways and demand management for commissioned services, and have responsibilities to advise PCTs of any breach in standards. Where failures in performance are identified, the clinical knowledge of practice-based commissioners may be important in the investigation and performance discussions with providers.

Important because…

• Commissioners need to be assured the service being delivered is what was specified

• Any issues can be addressed with the provider swiftly

• The public needs to be assured that health services are providing value for money

How to go about it

• Involve patient forums in identifying measures of quality

• Build these into the service specification and include in the contract alongside activity and other measures of performance

• If your SHA has a local Commissioning for Quality and Innovation (CQUIN) scheme, there is an opportunity to include incentives against particular quality measures

• Ensure the contract includes practical details of how the provider will submit routine information, what other information will be used to assess performance, and how unsatisfactory performance will be dealt with

• Include monitoring on patient satisfaction, finance and clinical governance

• Hold regular meetings to review the information

• Ensure that practice-based commissioners work together with PCT commissioners to investigate and address any poor performance issues

Background/relevant policy

The context for performance monitoring is set out in the 2009/10 operating framework and detailed guidance on NHS standard contracts for acute hospital, ambulance, mental health and community services can be found on the Department of Health website.

Pitfalls to avoid

Effective performance management is not just data collection – it also requires organisational capacity for analysis, investigation, negotiation and action.

Michelle Webster is national commissioning lead and Beverley Slater is national knowledge management lead for the Improvement Foundation

Patient satisfaction rates should be part of the monitoring process

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