Clinician-led commissioning forms one of the most radical elements of the Government’s NHS reforms. We have an established expertise in the area of commissioning and have an ongoing programme of work in this field, drawing on national and international evidence and best practice. We aim to support policy-makers and practitioners as groups of clinicians get set to take control of around £60bn of the NHS budget.
Under reforms outlined in the Government’s NHS White Paper: Equity and Excellence: Liberating the NHS, GP-led consortia – now clinical commissioning groups – will take over responsibility for commissioning the majority of NHS services in England, with primary care trusts (PCTs) due to be abolished by April 2013. All GPs in England will be required to join one of the clinical commissioning groups, which will begin to assume their new statutory responsibilities from 2013/14.
The Nuffield Trust is well placed to help ensure that the implementation of the reforms draws on the best available evidence – not only from the history of primary care-led commissioning in the NHS in England, where our experts have two decades' worth of experience in research and development support, but also from changes to the way international health systems commission health services. We have conducted a number of studies into international approaches to primary care-led commissioning, including in the United States, Australia and New Zealand.
Supporting local commissioners
To help GPs and other clinicians make a success of the reforms, we are establishing a network of clinical commissioning groups to allow them to exchange information, peer learning and a space to ‘test out’ commissioning plans among peers. Policy-makers, senior health care managers and clinicians and academics will also be able to get involved in our work in this area through our seminar series on the strategic challenges facing clinical commissioning groups, conferences and other events.
Our seminar series, covering themes which will support the strategic development of commissioning consortia, and the identification of core values and goals, started in April 2011. The policy and practical issues identified during the seminars will be drawn together in a Nuffield Trust report to be published in 2012.
We are well placed to help ensure that the implementation of reforms to commissioning draws on the best available UK and international evidence
Our international work on commissioning has seen our researchers examine the experiences of doctors’ groups in the United States, who have held the equivalent of a commissioning budget for the past two decades. At the time of the publication of the NHS White Paper in July 2010, we visited four doctor-led groups in California and discovered a number of important lessons for the NHS in England. The findings are published in our report: GP commissioning: insights from medical groups in the United States (January 2011).
Supporting national commissioners
We are carrying out policy analysis to inform the development of NHS England (formerly, the NHS Commissioning Board), drawing on research and practice in a selection of nations within the Organisation for Economic Co-operation and Development (OECD), and publishing analysis of the criteria needed for the board to work most effectively. A report will be published in autumn 2012.
In autumn 2012 we are facilitating an international masterclass for NHS England and Monitor, bringing international health managers and policy-makers to the UK to share their experience and insights about operating a national funder/commissioner at arm's length from government.
In addition, we will examine and analyse emerging guidance on NHS England.
Working in partnership
We regularly work in partnership with other high-profile national organisations in carrying out evidence-based analysis of the issues associated with clinically-led commissioning. In June 2010 we published: Giving GPs budgets for commissioning: what needs to be done?, a joint publication with the NHS Alliance, National Association of Primary Care, Royal College of General Practitioners, The King’s Fund and the NHS Confederation.
Another completed partnership project with the NHS Alliance examined how practice-based commissioning (PBC) could be extended to involve specialists and other clinicians. In November 2009 we published: Beyond Practice-based Commissioning: the local clinical partnership, which explores the possibility of developing multi-specialty groups of clinicians (GPs as well as hospital-based specialists) to take responsibility for the provision and commissioning of local health care.
