What is co-commissioning?

“For the first time this plan commits all governments to work together to achieve integration in planning and service delivery at a regional level… integration is concerned with building relationships between organisations that are seeking similar aims … [it] recognises that Primary Health Networks (PHNs) and Local Hospital Networks (LHNs) provide the core architecture to support integration at the regional level [and] work in partnership with regional stakeholders to build a consensus around what needs to change and when.”

The Fifth National Mental Health and Suicide Prevention Plan, COAG (2017)

“Joint processes, particularly those in partnerships with Hospital and Health Services (HHSs) and PHNs, are needed to ensure that local priorities and identified service needs are taken into account.”

Connecting care to recovery 2016-2021, Queensland Health (2016).

“Ensure formal collaboration between LHNs and PHNs to improve population health and the effectiveness and efficiency of primary health care. Where relevant, involve other regional groups with capabilities in managing population health, including Local Governments and community organisations.”

Shifting the Dial: 5 year productivity review, Productivity Commission (2017)

As seen in the above examples, the policy environment is increasingly calling for more integration, coordination and collaboration in how health services are planned and purchased.

‘Co-commissioning’ is a term used when describing the coming together of two or more commissioners/funders of health or social services to jointly address an issue. It can take several forms, ranging from joint planning and coordinating of separate commissioning activities all the way through to the pooling of funds and procuring services together.

As the 31 PHNs across Australia continue improve their capability and effectiveness in health service commissioning, the current policy setting will require PHNs to apply their commissioning frameworks in a more integrated and collaborative way via co-commissioning.

Opportunities for co-commissioning

In the PHN environment, there are generally two routes where joint commissioning is a priority:

  • PHN to LHN, regarding the coordination of service between the community and acute/hospital-based health services

  • PHN to PHN. regarding the planning and purchasing of services across regional boundaries.

Much of our work with PHNs in health planning, service design and evaluation leads to the identification of opportunities where PHNs could or should partner with other commissioners to address an issue.

One such example of this is in mental health services, where genuine opportunities exist to enhance coordination from hospital inpatient discharge or emergency presentation back to effective management in a person’s community through primary care and psychosocial supports.

Similarly in palliative care, we have seen real opportunities for PHNs and LHNs to improve the capacity and capability of community-based palliative care services to prevent unnecessary hospitalisation and support people to die in comfort at home.

In October 2017, we were engaged to support a working group of the CEOs of each of the Queensland PHNs with a rapid scoping exercise focused on improving ‘co-commissioning’ of mental health and alcohol and other drug (MHAOD) services in Queensland. The scoping process sat within the broader context of change for PHNs in their role as commissioners of MHAOD services, and a policy environment described above that is increasingly driving the concept of integrated commissioning.

Since completing this rapid scoping exercise in 2017, co-commissioning has very much remained on the agenda for PHNs across Australia, highlighted in the examples below:

  • The Victorian and Tasmanian PHN Alliance has taken strides forward in inter-PHN collaboration through their vision “to optimise the collective capabilities of the Alliance PHNs as a sector, proactively align efforts and advance primary care reform with a jurisdictional purview, that extends from Victoria and across the Strait to Tasmania.” They have outlined their commitment to harnessing collective opportunities via “agree(ing) investment strategies and new revenue opportunities to optimise the capacity of the PHN sector and enable best investment of all available funding.”

  • From a PHN-to-LHN perspective, the Metro North HHS and Brisbane North PHN have continued to build momentum via The Health Alliance - “an approach to tackling health and healthcare problems that transcend the mandate of any one organisation or part of the health sector, and that can’t be fixed by existing approaches.”

Consistently applying collaborative approaches to problem-solving between PHNs and state-funded LHNs can only result in better outcomes for people. At a minimum, services will be commissioned with other parts of the system in mind. Best case scenario, services will be commissioned via partnered approaches ensuring that services are ‘joined up’ and not showing signs of fragmentation that are so often observed in the Australian health system due to Federal-State funding splits.

Applying co-commissioning approaches

Our take on whether co-commissioning will continue to gain momentum among PHN and hospital services is a resounding ‘yes’. A few of our musings on this topic include:

  • Many staff working in the PHN environment who are strategic thinkers support the co-commissioning of health services

  • PHNs will tackle this in a number of ways and we think that diversity of approach is a good thing

  • Some PHNs are more ready to champion co-commissioning arrangements than others. We do however think that all PHNs can be taking steps in the right direction

  • Some service types are ‘co-commissioning ready’ now while other program areas require deeper scoping

  • Co-commissioning conversations require engagement at a senior level with ego left at the door. Some PHNs and LHNs will have to wait for a change of leadership to progress co-commissioning discussions.

  • Mandated integrated planning processes are the ideal vehicle to start co-commissioning conversations and improve the visibility of co-commissioning opportunities.

We believe that co-commissioning will remain on the PHN agenda into the future. If a dedicated approach to enhancing co-commissioning capability across PHNs is delivered, we will see more examples of co-commissioning activity. As always, sharing examples of what works and what doesn’t (and why) is critical to help the sector to learn and grow.

PHNs are already starting to experiment with co-commissioning approaches for program areas that are ‘implementation ready’ and while maturity for co-commissioning develops PHNs can be building the ‘implementation readiness’ of other program models over 3-5 years.

As a mission-based health and social services consultancy, Beacon Strategies is committed to partnering with PHNs to better plan, design, implement, evaluate and communicate their work in delivering health outcomes for local communities. Click the button below to access other insights from our recently completed PHN work or head to www.beaconstrategies.net/phns