The design and delivery of CQRS Local embraces the NHS approach to agile working

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Medical team in meeting

Andrew Mason, Lead Delivery Manager for NHS North of England Commissioning Support Unit, heads up the Calculating Quality Reporting Service (CQRS) Local development team. He has been part of the wider agile working CSU collaborative programme since it commenced in 2018.

Throughout the whole product development of the launch, Andrew has worked closely with the service users. This has helped to drive greater efficiency of the system, how it will work and how it will best meet their needs.

Agile working

“The design and delivery of CQRS Local embraces the NHS approach to agile working, interacting with service users who’ve been fully involved in the full product development lifecycle. This has been beneficial to design a system which is user centric and more bespoke.”

End user working groups have been involved since the start of the build, providing instant feedback from the user base as well as various user forums. Whilst giving them the opportunity to express how the new system meets their expectations.

CQRS Local has been developed as an extension to the national system, to help address some of the issues of claims processing. Whilst giving commissioners more flexibility to create and manage their own local incentive schemes.

“Current manual processes are inefficient and time consuming for commissioners and practices. There isn’t a national tool which provides a clear audit to both parties in terms of managing local incentive schemes. We trialed a tool based on a product which is successful in the North East and that is how CQRS Local was developed.”

Ambitions for the future

CQRS Local has its ambitions for the future, it’s a flexible system which can be adapted for different uses, which include reuse of vaccine stock. There is also the potential to diversify into other sectors, whilst considering ongoing agile working arrangements for multiple teams.

“One of our longer-term aims is to expand the user base from GPs and commissioners to wider providers of care and the ICB transition has really opened the doors for us to do this, and we look to progress this over the coming years.“

The vision for CQRS Local is quite simple. Short-term objectives have been to make the system live whilst making sure it meets the needs of commissioners as they transition from CCGs to ICBs. Whilst commissioning transitions to a more primary care network (PCN) centric approach.

“As with GP practices, it’s how we built CQRS Local, it’s flexible, a provider-commissioner relationship. Where PCNs are delivering schemes, they are able to submit claims much like GP practices and it gives commissioners greater flexibility over who they commission to deliver schemes whether on a practice or PCN level.

“Our longer-term ambitions are to deliver a full end-to-end process that links into both clinical systems and payment systems before and after, so we can provide a fully automated end-to-end service which is efficient and meets the user’s needs.”

Continual development

The national CQRS programme is used across the country to collect data from GP practices including GP payments. It has been successfully supporting GPs and commissioners to manage payments for Directed Enhanced Schemes (DES) for example, for several years.

However, CQRS Local goes one step further for commissioners. It gives them a tool to track and monitor claims going through the system and a reporting mechanism. Commissioners can manage locally defined incentive schemes that are bespoke to certain areas of the country, and respond to commissioning requirements within a local landscape. Whereas the existing CQRS system is nationally based and not as reactive.

“With any new system, we are continually developing its functionality and reacting to the needs of commissioners to provide a bespoke system. In the short-term, we can look at CQRS Local linking to the PCSE finance system, and long-term, how we integrate it directly into clinical systems to make it more streamlined for practices and beneficial in terms of time savings so they can automatically extract it from their clinical system into CQRS Local.”

The initial success of CQRS Local has come down to delivering it as a collaborative with a dedicated training team, service desk and development team working together and independently on their own sections.

“Working as a collaborative has resulted in a high-quality service wrap which users have seen the benefit of together with more efficient working.”