Commissioning high-quality care for people with long-term conditions

^{Dr Alison Porter, report co-author discusses the main findings of the Nuffield Trust research into what commissioners do on a day-to-day basis.}

Effective commissioning is a core priority of the coalition Government’s reforms to the NHS in England. There has been extensive research into the effects of commissioning over the last two decades, but little analysis of what commissioners actually do.

The Nuffield Trust was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, to conduct a two year study of commissioning practice in three high-performing primary care trust (PCT) areas (Calderdale, Somerset and the Wirral).

This research summary authored by Dr Judith Smith, Dr Alison Porter, Dr Sara Shaw, Dr Rebecca Rosen, Ian Blunt and Professor Nicholas Mays is based on a full report available on the NIHR website.

Commissioning should involve the drawing together of different professionals and interests around the common cause of services that can better meet patients’ needs Lead investigator and Nuffield Trust Director of Policy, Dr Judith Smith

Several key themes emerged from the study, including:

• The question of money – the role of money in commissioning practice was observed to be intermittent and at times peripheral;

• The scale and pace of change – tackling ‘bite-sized’ commissioning tasks as part of a wider local plan for service delivery was seen as being more likely to lead to success;

• External drivers of commissioning – national guidance provided top-down impetus to get things done, presented templates for services, and provided a framework for local decision-making and the identification of priorities.

The authors warn that new clinical commissioning groups (CCGs) will, in a climate of financial austerity, need to make sure that, alongside collaborative discussion and service planning, they leave space for transactional work such as contract specification, service review and decommissioning.

Commenting on the report, lead investigator and Nuffield Trust Director of Policy, Dr Judith Smith said:

‘Commissioning should involve the drawing together of different professionals and interests around the common cause of services that can better meet patients’ needs.

‘This research revealed the ‘labour’ of commissioning to be extensive and resource-hungry, especially when designing and specifying services. What was less evident was a robust approach to assessing the performance, quality and impact of local services, and willingness to provide necessary challenge to existing local providers.

‘With less money available for NHS management, the new generation of commissioners will need to pay close attention to the cost of their practice, and display rigour in setting clear and measurable objectives for a programme of commissioning work.’