Comment

05.12.18

The future of commissioning

Source: NHE Nov/Dec 2018

Julie Wood, chief executive of NHS Clinical Commissioners, reacts to Matt Hancock’s recent comments regarding commissioning.

“Commissioning is very, very important, and the split between commissioners and providers is important because you need to keep a financial grip on the system.The question is, at what level do you commission? The concept of an integrated care provider is that you are commissioning at one level higher, over a geography rather than for individual services. I’m instinctively in favour of using commissioning to keep a grip on the system and make sure we get value for money, but I’m sceptical of using those mechanisms where the siloes that they require are a barrier to improving things on the ground.”

After three months in the job, it was good to hear health and social care secretary Matt Hancock talk about commissioning. It was particularly reassuring that he thinks commissioning is “very, very important.” Unsurprisingly, as the independent collective voice of clinical commissioners, we completely agree.

Since the creation of clinical commissioning groups following the Health and Care Act 2012, clinical commissioners have been using their local knowledge to commission services that are appropriate for the needs of their patients and populations. And it is important to retain this clinically-led commissioners role within the evolving system.

The secretary of state is right when he says that commissioners are essential to keeping a financial grip on the system, and even more so in a period which has seen the biggest-ever squeeze in NHS funding. They will have to continue to make difficult decisions even as CCGs start to receive their share of the £20.5bn funding settlement in order to ensure that every single pound is spent to the very best effect.

But the job of clinical commissioners is not just keeping track of how money is being spent; it’s also about innovating and adapting to get the best value for each precious NHS pound. Part of that is to have a conversation with the population about what the NHS should fund. Over the past year we have worked with NHS England and other national partners to develop guidance to curb the prescribing of items that can be easily bought over the counter and reduce the number of inappropriate interventions being performed. This work will continue as new evidence and new technology becomes available, but we must also look at the bigger picture.    

The direction of travel is towards greater integration and closer collaboration between commissioners and providers, and between health and care. Hancock is right: health and care services need to be commissioned at system level, across an appropriate geography. But we need to commission at place level, too. The future of commissioning cannot be siloed; we need to look at commissioning for a pathway of care, and think creatively about who provides those services.

This is already happening in a number of areas of England, but we know from our members that there are some regulatory barriers which are preventing this from happening as smoothly as it should. For example, rules around procurement, competition, and choice mean that commissioners feel compelled to put service contracts to tender, even when the provider is meeting performance and VFM targets. Our members would like to ensure that this is only needed if the commissioner cannot secure the transformative changes needed with the providers working within the place and system.

There are also cases where formal mergers of NHS organisations have been prevented due to competition rules, which we would like to see changed, as well as reform of the payment system to better reflect the increasing collaboration and integration already taking place.

Removing these barriers may require legislative change, but many can be done simply by using current legislation in a different way to achieve financial sustainability and the best health outcomes for our patients and the population.

Top image: Stefan Roussea via PA Images 

 

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