If specific services do not appear to be working to the satisfaction of either commissioner or provider, disputes can arise as to the way forward. Typically these disputes initially arise over contractual issues such as referral patterns, quality outcomes or payment pressures. However, in our experience, to solve the root cause of such problems and independent review of the service provided, together with options for re-design if required, can enable both parties to move on.
To do this, we often co-opt our associates that have a medical, nursing and operational background. We can then walk the current service to gain direct insight into current issues. We can discuss the good and bad points of the current service with the staff working on the front line and other provider and commissioner colleagues. This ensures that a clinical consensus as to the options for the way ahead can be developed as the first step.
The next step is to map out graphically the current and proposed pathways and present these to workshops involving provider and commissioners. The aim of the workshops is to reach mutual agreement on the desired pathway for the contract – one that the commissioner wishes to buy and one that the provider can deliver.
In our experience, developing a new and mutually agreed pathway for a service provides a firm foundation for resolving contractual disputes that have arisen over activity, quality and payment. The next step is to formalise the pathway into a service specification that can be inserted into the contract as a schedule, which then binds commissioner and provider to deliver what has been agreed.
Bailey & Moore have considerable experience in helping commissioners and providers map service pathways and agree the content for a new or revised service specification.