Investigating recent developments in the commissioning system

Valerie Moran, Pauline Allen Pi*, Imelda McDermott

*Corresponding author for this work

Research output: Book/ReportCommissioned reportpeer-review

Abstract

Background
The Health and Social Care Act 2012 (HSCA 2012) introduced major changes into the commissioning system for the English NHS in 2013. Primary Care Trusts (PCTs) were replaced with Clinical Commissioning Groups, clinically-led statutory bodies responsible for the planning and commissioning of health care services for their local area. A new arms-length body, NHS England (NHSE), was established with responsibility for overseeing the work of CCGs. Commissioning responsibilities for local populations are now divided between CCGs, local authorities and NHSE. Since the HSCA 2012 took effect, there have been several important policy developments, which affect the ‘new commissioning system’. First, in 2014, The Five Year Forward View (5YFV) focussed on how organisations in the NHS need to cooperate with each other, and form new configurations known as ‘new care models’ (NCMs), the first wave of which have been designated ‘Vanguards’. There are also other organisational and service delivery changes being implemented across the country, designed to improve the integration of care. These changes take a range of forms including both horizontal and vertical integration. In 2015, the relevant NHS national bodies issued a further policy document introducing the concept of local cooperative, place based planning, initially known as Sustainability and Transformation Plans and from March 2017 Sustainability and Transformation Partnerships (STPs). There are 44 STPs, almost all of which include several CCGs, and many of which include seven or eight. Therefore, it will be necessary for CCGs to work together to provide system leadership in their local economies, as well as find a way to work with local providers. Despite these developments, there have been no relevant legislative changes, so the HSCA 2012 provisions concerning the respective roles of NHS commissioning organisations and the regulatory framework in respect of both procurement and provider competition remain in force. There is now a more complex local landscape of organisations all of which need to be involved in the planning of local services; and CCGs need to be able to find ways to engage with them effectively. This project investigated the initial stages of this process.

Aims
The questions addressed by the research were:
1. How are CCG internal processes of decision making changing?
2. What is the role of the individual CCG in the current commissioning landscape?
3. How is accountability maintained by CCGs in the current commissioning landscape?
4. How is competition and the current pricing regime relevant to CCGs’ commissioning decisions?
5. How should commissioning develop?
Design and Methods The design of the study consisted of three case study sites centred round three CCG areas, spread across England. Our main method of data collection was interviews with senior commissioners in the CCGs and senior managers in a selection of local provider organisations and local authorities. We collected additional data by examining locally produced documents, such as STP plans. Data collection took place between November 2017 and July 2018. Data analysis was conducted using a thematic analysis derived from the research questions.
Original languageEnglish
Place of PublicationLondon
PublisherPrucomm
Number of pages92
Publication statusPublished - Sept 2018
Externally publishedYes

Publication series

NameReport for the Department of Health and Social Care, UK
PublisherPRUComm

Keywords

  • public health report

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