Commissioning Support

A new challenge for commissioning

The NHS experienced a decade of unprecedented investment, during which the commissioning process was used to translate this investment into improved access, improved quality and improved health outcomes.

Commissioning is the process of specifying and procuring the health and social care services that are most likely to improve health outcomes.  Internationally, integrated health plans like Kaiser Permanente, Veterans Health Adminstration, the German Allgemeine Ortskrankenkasse, all commission services for their members.  In America and Germany, provision has been a largely free, if regulated, market.  In England, the political trend towards the creation of a managed market has been redirected to a srong focus on an outcomes-based commissioning approach led by GP Commissioning bodies. The approach of PCTs that started to encourage substantial private sector involvement in some niche markets such as diagnostics and planned surgery is likely to continue.  In Scotland, the market operates in favour of local monopolies.  In Wales, there has been a policy decision to end the internal market, so that most services outside primary care are delivered by the local monopoly provider except where patients elect to cross the border into England.

In all these systems, however, there is a recognised role for commissioners, who analyse the trends for population need and demand and seek to match services to it.  For the last ten years, increasing demand has been met, if not matched, by rising investment.  Now, as the era of planned investment ends in the most challenging fiscal context for a generation, commissioning faces a new and urgent expectation: that it will enable the NHS system to improve quality through a period of unprecedented falls in public spending.  Combined with a sharp shift away from process targets toward health outcomes, the new GP Commissioning bodies in England will face a major challenge. 

Expressed in simple productivity terms, their task will be to achieve better (and more) health outcomes from the same or even fewer resources.

Helping Commissioners

Commissioning is shifting its focus from how best to invest new money to improved spending of all the money.  GP Commissioners, focused on health outcomes, will pick up a powerful baton, especially from PCTs who made this shift.

Medical Mosaic learnt a lot from helping commissioning bodies, especially with:

• Managing parallel programmes of commissioning, each with capability to assess need, plan the interventions needed, design the services and procure them.
• Creating innovative means of engaging the providers needed to operate true end-to-end services.

Added to all this rich legacy, the GP Commissioning bodies will need very rapid organisation development.  Medical Mosaic's approach to programme management in commissioning will be well-placed to provide short, sharp processes to be functioning as quickly as will be needed.