Drug Action Teams

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How to form a Joint commissioning Group

Joint commissioning groups (JCGs) without clear aims and objectives, without terms of reference understood by its members and the groups to which it links, and without consistent and appropriate membership, will often flounder in conflict and misunderstanding. There are a number of significant questions to resolve at a very early stage. The following list is not exhaustive, but it indicates the tone and importance of some of these issues.

Are there clear aims/objectives for this group?
This will influence the answers to any other questions and should be clearly understood by all involved. For example, is the aim of the group to develop a model of joint commissioning for use by another existing group (such as the DAT), or will this group be responsible for (and supported in) making decisions on allocations of expenditure?

The former type of group could meet regularly at first to develop a model, then meet on a less frequent basis to review the model and comment on its use by the -parent- body. The latter type of group would require regular meetings, its own planning cycles and greatly increased responsibility for the membership.

Are there natural boundaries for this group?
Many JCGs for substance misuse services form along DAT boundaries, but this may not always be the most appropriate decision. Boundaries of agencies are affected by other initiatives (such as single regeneration budgets, health action zones and New Deal for Communities), so these should be considered. You should also consider the views/perceptions of the communities directly or indirectly benefiting from the services.

Who should be a member of the JCG?
Membership needs to represent all the agencies influenced by the National Drugs Strategy that are responsible for overseeing the purchase (in the broadest sense) of services. This will be a wider membership than simply those involved in the provision of treatment and social care. However, the criteria for membership will depend on the aims and objectives that are decided for the group.

A model-making group (as described above) needs a clear understanding of the pressures and priorities within the system, local decision-making processes and financial systems. It also needs a grasp of how to plan strategically across a range of borders (agency, geography, demography of client, position in the national strategy etc).

A decision-making group (as described above) needs a model with which to work, but also requires each member to carry sufficient seniority to speak with authority for the budget/resources they represent, without fear of contradiction at other levels in their organisation. This can be an issue in agencies that are new to this arena.

Is there a role for service providers on a JCG?
This issue will be influenced by the aims of the group. It is legitimate to challenge the role of provider agencies in decisions on financial allocations that involve their service. However, any model that is developed needs to build in -expert- views and sometimes these experts will be the people responsible for providing services.

At this stage, it is a good idea to consider implementing a Best Value framework, which requires any service under consideration to be widely compared with other possibilities, while still noting the importance of meeting local need. With an active network, expert views can be compared with neighbouring or comparable regions.

Input from a wide range of service providers is crucial in developing a workable joint commissioning model. Voluntary or private-sector providers and self-help groups may be influenced by the adoption of such a model and their co-ownership of the process will assist in its implementation.

How does the JCG link with other groups?
Whatever the remit of the JCG, its links with the DAT and drug reference group are important. Members should be encouraged to promote the aims of the group in other aspects of their work and other planning forums, in an attempt to route all decisions about substance-misuse services through the appropriate mechanism. This is important when considering initiatives that address the social-exclusion agenda, where substance use is likely to be an issue.