Commissioning healthcare in England : evidence, policy and practice;evidence, policy and practice

This book brings together selected research on commissioning healthcare in the English NHS carried out by national policy research unit in commissioning and the healthcare system (PRUComm) between 2011 and 2018. PRUComm is funded by the English Department of Health’s Policy Research Programme. The bookexplores the changes to commissioning in the English NHS quasi market introduced by the Health and Social Care Act 2012 (HSCA 2012). It focuses on threemain areas: first, the development and operation of the newly formed commissioning bodies named Clinical Commissioning Groups (CCGs) which were supposed to increase clinical engagement; secondly, technical aspects of commissioning being the use of competition and cooperation by CCGs to commission care in the HSCA 2012 regulatory context encouraging competition,and the allocation of financial risk through contracts between commissioners and providers of care (including new forms of contract such as alliances); and thirdly the reorganisation of the commissioning of public health services.The research demonstrates that the HSCA 2012 has had the effect of fragmenting commissioning responsibilities and in the process impaired good governance and strong accountability of commissioners. It shows how the use of market mechanisms has declined despite the pro competition regulatory regime of the HSCA 2012, and that more cooperative processes are used at local level to reconfigure health services. It concludes that strategic planning and monitoring of services will always be essential for the English NHS, whether the term ‘commissioning’ is used to describe these activities or not in the future. Front Cover Commissioning Healthcare in England: Evidence, Policy and Practice Copyright information Dedication Table of contents List of figures and tables List of abbreviations Notes on contributors Acknowledgments 1 Introduction Introduction Theoretical bases of the research Structure of the book 2 Context: commissioning in the English NHS Introduction Internal market/purchaser–provider split – the origins of ‘commissioning’ Coalition government – HSCA 2012 Architecture of commissioning post-HSCA 2012 Clinical Commissioning Groups (CCGs) NHS England (NHSE) Public Health England (PHE) Local Authorities (LAs) Public Health Health and Wellbeing Board (HWB) Regulators Monitor Care Quality Commission (CQC) Contracts Developments since the HSCA Five Year Forward View Sustainability and Transformation Plans and Partnerships Accountable and integrated care 3 The development and early operation of Clinical Commissioning Groups (CCGs) Introduction Design and methods Case studies Interviews Results Engagement with members Commissioning activity Conclusion 4 Clinical engagement in commissioning: past and present Introduction The history of GP-led commissioning in the NHS Evidence from the past Evidence about the nature of clinical involvement in the commissioning process Engagement and outcomes Summary GP ‘added value’ in CCGs Design and methods Programme theories: how do GPs ‘add value’ to commissioning? Clinical leadership and decision making Theory 1 (GPs’ knowledge about patient experiences) and Theory 2 (GPs’ knowledge about services) Theory 3 (clinician-to-clinician discussions) Theory 4 (clinician–manager symbiosis) Summary Conclusion 5 Commissioning primary care services: concepts and practice Introduction History of primary care commissioning and financing in England Policy objectives Study design and methods Interviews with senior policy makers CCG application documents Telephone surveys Case studies Programme theory versus the practice of co-commissioning Theory 1 Theory 2 Results Co-commissioning activity Comparison with Practice-Based Commissioning (PBC) Conflicts of interest Locally based primary care plans versus wider national initiatives Unintended consequences Discussion 6 Commissioning of healthcare through competitive and cooperative mechanisms under the HSCA 2012 Introduction Study design and methods Findings Understanding and experience of the regulatory framework under HSCA 2012 Changes in understanding of the regulatory framework after the publication of the five year forward view Use and experience of competition and cooperative mechanisms under HSCA 2012 Changes in behaviour following the publication of the FYFV Conclusion 7 Healthcare contracts and the allocation of financial risk Introduction Pricing and payment structures in the English NHS Pricing and the allocation of financial risk Provisions of the national standard contracts Negotiation, monitoring and enforcement of contracts Context for contracting New models of NHS contract: the allocation of risk across providers New models of contracting in the NHS Background Provisions of the contracts The allocation of financial risk in practice Agreement of the allocation of financial risk Discussion 8 The changing public health system: an examination of the new commissioning infrastructure Introduction The political backdrop Commissioning public health – then and now Research in a changing landscape: The PHOENIX study Results The new context for commissioning Commissioning processes and people involved Commissioned services: what has changed? Discussion 9 Conclusion References Index Back Cover This book provides a unique resource about research on commissioning in the United Kingdom's National Health Service. Using the outputs of an eight-year research project on commissioning, the book supports a greater understanding of how commissioning operates and how it can improve services and access, increase effectiveness and respond better to patient needs. The book covers a wide range of issues in commissioning and health service organization including the development and operation of Clinical Commissioning Groups (CCGs), commissioning through competition and cooperation, the use of contractual mechanisms in commissioning, and the commissioning infrastructure for public health.

This timely book is the most comprehensive account yet of recent commissioning practice in the English NHS and its impact on health services and the healthcare system. Drawing on eight years of research, expert researchers in the field analyse crucial aspects of commissioning, including competition and cooperation, the development of Clinical Commissioning Groups and contractual mechanisms. They also consider the influence of recent commissioning reforms on public health infrastructure. For academics and policy makers in health services research and policy, this is a valuable collection of evidence that deepens understanding of how commissioning works.