Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes

Abstract

ObjectivesTo explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need.DesignA multisite, quasi-ethnographic exploration of 9 CCGs.SettingNational Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas.Data collection/analysisContent analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30 hours).ResultsObservations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services (‘person-centred’, whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.ConclusionsCommissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic planning of lay involvement to provide an avenue for genuine engagement, so that support can be provided for communities and individuals in a way people will engage with.

Self-management support preferences of people with asthma or chronic obstructive pulmonary disease: A systematic review and meta-synthesis of qualitative studies

“…Chronic Illness 17 (3) disease management policies including SMS frameworks. [11][12][13] In addition, few studies have sought patients' views on the desired outcomes of disease management. 14 Research suggests that patients may place importance on characteristics of SMS that may not have previously been considered key aspects of interventions.…”

Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews

“…In this regard, integrated care might exist in multiple forms, and various interventions have been proposed. Some interventions, such as self-management (SM) aim to increase personalisation and self-care, supporting medication adherence or condition-specific education 8. On the other hand, other interventions such as case management (CM), multidisciplinary teams (MDTs) and discharge management (DM) form a collaborative process that includes communication between care givers themselves and with patients across different settings 9.…”

Facilitators and Barriers and Self-management in Adults With Multiple Sclerosis

“…Evidence shows a positive relationship between the self-management of MS and improvements in clinical outcomes, including improved QoL, reduced disability, and lower treatment costs. Additionally, experts recognize self-management as an effective strategy that facilitates the achievement of highquality, long-term care, improved outcomes, and the appropriate utilization of services while ensuring increased patient con dence, reduced anxiety and unplanned admissions, and improved adherence to treatment and medication regimens (Reidy et al, 2016).…”