Integrated commissioning: Making a difference

Source: NHE July/August 2018

Dr Graham Jackson, co-chair of NHS Clinical Commissioners (NHSCC) and clinical lead for the Buckinghamshire integrated care system, makes the case for integrated commissioning. 

There is a lot of talk at the moment about different types of commissioning: strategic, tactical, clinical, specialised, joint, local authority, and more. Historically, health and care services have done the bulk of their commissioning separately, but like other parts of the health and care system, it is time to move away from this silo thinking and consider integration. 

Much of the move to integration thus far has focused on increasing the merging of provision, and it’s fair to say that we now have a clear idea of what the delivery of integrated care will look like from a provider perspective. It is important that we align commissioning where we can too, but the vision for how we do this is currently less clear. 

NHSCC recently led a session at Confed18 where colleagues discussed the difference that integrated commissioning can make for patients and populations. From this session and conversations with NHSCC members, it’s clear that commissioners believe that this change is a move for the better: joined-up services across a larger footprint enable us to work at scale – the pooling of resources and elimination of duplicate processes frees up funding to use elsewhere in the local area – but also provides a consistent patient experience whilst keeping the focus on the needs of the population. 

As we move towards integrated delivery of health and social care, the commissioning function remains essential to provide oversight and ensure we have the breadth of services we need as the systems we work in evolve. Commissioning will also provide overarching quality assurance that the NHS pound is being spent most effectively to gain maximum value. 

To fully grasp this opportunity, strong clinical engagement is key; the evidence in NHSCC’s recent briefing on strategic commissioning demonstrated the feeling among our membership that if strategic commissioning is to live up to its potential of creating a sustainable healthcare system which delivers more for patients, it must build on the progress that CCGs have made.

Integrated systems pose the additional challenge of spreading that clinical leadership much wider, in a multi-professional way, including social care colleagues. Unless we think like this, we won’t ever effectively integrate commissioning or provision.

Integrated systems are, by definition, place-focused. Two recent publications from NHSCC show that commissioners believe that an approach which is both place- and outcome-focused is the right one to deliver a sustainable NHS that meets the needs of their populations. 

We must have a mindset of continuous quality improvement, which must be based on the needs of the population. What quality improvement looks like in Buckinghamshire is different from what is required in Blackpool, for example. Drawing on the long-term planning cycles within local authorities and their deep understanding of the local communities means that integrated, place-based commissioning has the potential to go further than a more traditional approach. To this end, NHSCC has been working with the Local Government Association to develop the Integrated Commissioning for Better Outcomes framework, a practical tool for council and NHS commissioners.

Furthermore, we know that co-design and co-production of services, stemming from a genuine engagement with local people, is the right way to deliver services that are right for that population, and we need to do more of this when it comes to commissioning. New delivery methods may well need to replace outdated (but often cherished) services. The engagement and involvement of the local population in the design process will also help the collective understanding of why sometimes de-commissioning needs to take place to allow progress.

There are clear benefits of integrating health and care, and central to this are strong relationships between the different organisations across the health, care and voluntary sectors. We must therefore invest some of our resources in strengthening these relationships, as well as setting parameters of engagement and agreeing on behaviours.

Finally, we must strengthen the relationship with our local populations; the NHS is owned, funded by and exists to serve these communities. We should collectively use all assets available to strive for those improved outcomes and get the best value for public money. 


There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

NHS to benefit from £13.4bn debt write-off

03/04/2020NHS to benefit from £13.4bn debt write-off

In efforts to relieve some of the financial burden on NHS providers in light of the ongoing coronavirus outbreak, Health Secretary Matt Hancock h... more >
Health Secretary outlines plans for 100k coronavirus tests a day

03/04/2020Health Secretary outlines plans for 100k coronavirus tests a day

Health Secretary Matt Hancock has outlined a new five-pillar plan detailing the national efforts to increase testing in England, with an aim to c... more >
Government announce £300m support for community pharmacies

03/04/2020Government announce £300m support for community pharmacies

Community pharmacies are set to receive a £300m cash boost from the government to ensure they can continue to carry out essential service d... more >

the scalpel's daily blog

Why social prescribing is the future of healthcare

01/04/2020Why social prescribing is the future of healthcare

Jennifer Jones-Rigby, COO at Health Exchange, a social enterprise seeking to shape the design and development of health and wellbeing services in a way that will enable everyone to have the capacity and confidence to choose positive health and wellbeing. The medical profession is often overstretched, with too many resources used for preventable conditions. As such, the national health service is under increased pressure t... more >
read more blog posts from 'the scalpel' >


Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus

NHS SBS: A 21st Century NHS

02/04/2020NHS SBS: A 21st Century NHS

Sean Hopkins, Head of Programmes and Technolo... more >
Efficient respirator fit testing and infection prevention

19/03/2020Efficient respirator fit testing and infection prevention

Sponsored Content: TSI explain about respirat... more >