MANAGING COMMISSIONING INSURANCE
t“If insurance is purchased
hrough the general market,
it would certainly help with pricing if CCGs in their local area group joined together for buying power”
the risk pooling system and, hence, other participants,” is her first rule. Secondly, she asserts that each participant should pay a contribution to the pool that adequately reflects the risk each brings to it: “This should not just reflect the likelihood of random fluctuations in, say, service use and cost, but should also reflect the protocols the participant puts in place to manage the risk – for example, implementing and adhering to evidence based clinical guidelines.”
CHECKS AND BALANCES It’s important to remember that CCGs are also charged with checking that providers are adequately covered, as Ross explains: “All providers of NHS services will continue to have contractual obligations to maintain indemnity cover and CCGs will need to ensure that providers they contract with have adequate and appropriate insurance cover in place. This can be internally checked or the services of an insurance broker can be utilised to take over this responsibility.” She has also discovered that provision is another area of concern for the new groups: “From discussions with CCGs, their main area of concern is with conflicts of interest between board members and the contracts that are awarded to service providers. As they fall within the definition of an NHS body it does give protection from personal liability of members and officers of CCGs. It doesn’t, however, cover all potential liabilities and a general insurance product from the market should be considered to ensure full protection is given.” While the adjustment to insurance for CCGs may take a bit of getting used to, the rules aren’t greatly different in the new era of commissioning. The fact that all groups had to submit their own risk management framework as part of their business plan means that the systems should already be in place for a smooth transition. And it’s vital that this is the case, as Buckle concludes: “If the NHS is to successfully manage its budget and provide quality care, financial risk management must be a central facet to the on-going reforms.”
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