f1 gap analysis

8/4/2019 F1 Gap Analysis

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November 2006 1

Gap analysis key factors

Alignment with needs

Quality of services

Cost of services

Risks in existing arrangements

Relationship with providers


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November 2006 2

Risk factors

Political opposition

Local community/pressure group challenges

Service user dissatisfaction/harm

Staff dissatisfaction/harm

Provider dissatisfaction

Provider financial problems

Bad publicity

Increase in cost of service

Litigation

The Competition Act

Judicial review

Other legal challenges


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November 2006 3

Cost factors

Staff : user ratio

Direct costs

Salary rates

Locum coverage

Overheads

Administrative / management costs

Margin for risk/contingency

Monitoring requirements or other transaction

costsCross subsidies or other income

Unit costs per week/hour

Charging policy


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November 2006 4

Value for money?

Understanding unit costs

Payment for enhanced quality or providing specialistservices

Compare like with like Benchmarking to establish reasonable costs

Investigate unreasonable costs

Link to outcomes and outputs of the service toestablish value for money

Appropriate services


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November 2006 5

Assessing existing services spectrum 1

Good alignmentwith needs

Poor quality Good quality

Poor alignmentwith needs


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November 2006 6


Low risk

Poor value formoney

Good valuefor money

High risk


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November 2006 7

Options for change

Disinvest or decommission services

Remodel services

Renegotiate or end contracts

Maintain contracts

Commission new services


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November 2006 8

Definition of options

Disinvestment or Decommissioning is the process ofplanning and managing the elimination or reductionof service activity or investment in services in line

with commissioning objectives.Remodelling is the process of negotiating changes to

the service specification with existing providers toensure that they align with needs.

Renegotiation is the process of improvingperformance in delivering contracts.

Maintenance is the process of ensuring continuity ofservice provision, price and quality.

Commissioning new services is the process ofsecuring services to meet new or changed needs.


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November 2006 9


Good alignmentwith needs

Poor alignmentwith needs

Maintain

Renegotiate or

end contracts

Decommission Remodel

Poor quality Good quality


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November 2006 10


Low risk

High risk

Renegotiate or

end contracts

Decommission

or remodel

Maintain

Remodel

Good valuefor money

Poor value formoney


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November 2006 11

Naming the priorities

Strategic commissioning objectives usuallyoutcomes for the population, 5 years, 7-8 maximum

Service development priorities specific changes to

meet the objectives, respond to original hypotheses,specify where and for whom the changes areintended. 3 years.

Rationale why existing services will not meetneeds, why service development is needed.

Procurement implications required disinvestmentor remodelling, redistribution of resources,contracting changes.


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November 2006 12

Service Design

Once strategic commissioning objectives,development priorities and implications are agreed,move into design and testing, through:

Exploring examples of research and good practiceelsewhere.

Scenario building and testing.


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November 2006 13

Scenario building

To ensure that they will actually meet the needs of service usersand will not have unintended negative consequences on theoverall whole system of service provision for the population.

Scenario building can help to predict and prevent problems fromthe beginning.

Range of approaches to service modelling and scenario testing,essentially based around the idea of a game which models thescenarios likely to prevail in real life if a particular service were tobe introduced.

Vary from the basic and simple for example, desk-basedactivities looking at the financial implications of changes toservices to role playing activities involving dozens of differentactors more or less successfully acting out what they imaginewould be the behaviour of different stakeholders in a particularnew scenario.

It can help all stakeholders test the feasibility of a proposedservice development, as well as identify additional guidance,protocols or arrangements needed to make the service work well.


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November 2006 14

Scenario building examples

Primary care CAMHS service: how the system wouldrespond to the needs of individual children or youngpeople though individual case studies.

Locality arrangements : how agencies in a locality

would organise their response to children withemerging behaviour problems, including pathwayand protocol design.

Joint commissioning arrangements: how a jointcommissioning team would manage an emerging

budget deficit problem.


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November 2006 15

Scenario building

Involve all key stakeholders including service users,carers, professionals and providers in differentfora if necessary.

Genuinely test arrangements get testers to identifystrengths and weaknesses.

Explore how weaknesses can be addressed forexample through resource allocation, protocols,guidelines, role definition, referral procedures.

Explore in detail transition implications and costs.


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November 2006 16

Procurement and market management plans

Procurement plans - how resources will bedistributed, and what services will be expected forthose resources. Usually 1-3 years, specifying whatwill be purchased or contracted, the volume of

activity, and the cost. Market management plans - identifying what

commissioners intend to do to ensure that servicesare specified, tendered, and contractedappropriately, including being clear about what

services will not be subject to competition andwhy.


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November 2006 17

Managing a quasi-market

The characteristics of a quasi-market include:

High degree of continuity in the personnel, and

long term relationships.Market-like mechanisms, including contracting.

A relational market.

Professionals often purchase services on the partof both the organisation and the client.

The market is often inward-facing, to minimiseservices failure.

Heavily regulated by central government.


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November 2006 18

Traditional weaknesses of a quasi-market

Potential for inappropriately strong influence ofproviders.

Service users have very limited mechanisms

available to them to influence the market. Service users have very limited choice of services

available.


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November 2006 19

A mixed economy of care

Most agencies support a mixed economy ofproviders public, voluntary and private.

Few agencies have an overall policy for developing

such a mix or have agreed targets for the balancebetween sectors.

Most agencies try to achieve a balance through smallincremental changes in commissioning.


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November 2006 20

Market management plan

Planned market configuration areas of growth orcontraction, balance between public, private,independent sectors.

Planned contracting arrangements what kind ofarrangements for supplier registration, specification,tendering and contracting will be used and where.

Transition management how major changes in themarket will be handled, approaches to be used to

decommissioning or service transition.


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November 2006 21

The commissioners role

Driving service change to meet needs.

Managing change to minimise service breakdown.

Managing the balance of interests of different

stakeholders. Managing the balance of power between different

stakeholders

Managing the process of engagement with differentstakeholders.


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November 2006 22

Consensus building issues

Stakeholders not prepared.

Meetings not facilitated.

Confusion between information, consultation,negotiation.

Pressure to respond quickly.

No framework for analysis.


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November 2006 23

Consensus building activities

Options:

Early information about the project and how to beinvolved

Active information giving, consultation, involvement

activities throughout

Service design events: multi-agency focus groups:key stakeholder interviews.

Scenario analysis.

Feedback/response documents.

Hypotheses/priorities testing.


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November 2006 24

Consensus building - summary

Plan the process well.

Involve stakeholders early.

Ensure decision makers are involved at the crucial

stages. Give written and oral feedback of results and

conclusions.

Give stakeholders time to think through and respondto each stage.

Individual comment and groupwork to work throughimplications of the strategy.

Consider honest brokers to facilitate.


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November 2006 25

Exercise

Go back to the earlier exercise where you plannedwork on a commissioning strategy for a specificpopulation.

Use the materials we have just reviewed to completean initial analysis of the market you are likely to bedealing with, its strengths and weaknesses, whatyou think your market management priorities arelikely to be, and why.

f1 gap analysis

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