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 

 

Enjoying NHE? Subscribe here to receive our weekly news updates or click here to receive a copy of the magazine!

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

PCN Network: Important people access primary care in way which suits them

10/07/2020PCN Network: Important people access primary care in way which suits them

Following the release of the findings from the latest GP Patient Survey, NHS Confederation’s PCN Network have stressed the importance of en... more >
NHS Test and Trace data shows 97.5% of tests returned the next day

10/07/2020NHS Test and Trace data shows 97.5% of tests returned the next day

As NHS Test and Trace have published the statistics for the fifth week of the service operating, demonstrating that 97.5% of in-person coron... more >
NHS SBS framework launched to help safe return of employees

09/07/2020NHS SBS framework launched to help safe return of employees

A new procurement framework has been launched by NHS Shared Business Services (NHS SBS) to help facilitate the safe return of NHS and other publi... more >

the scalpel's daily blog

NHS at 72: Managing mental health services going forward

03/07/2020NHS at 72: Managing mental health services going forward

Sean Duggan, Chief Executive of the Mental Health Network Let’s take this opportunity to reflect on the amazing achievements of our health system over the past few months. But as we recognise the best of the NHS and its response to the Covid-19 crisis we must not forget that for mental health the peak has yet to come. Covid-19 has placed enormous pressure on the entire health and care system. Despite the very real hardships f... more >
read more blog posts from 'the scalpel' >

interviews

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

26/06/2020Adapting and Innovating

Matt Roberts, National Health Executive Editorial Lead. NHE May/June 2020 Edition We’ve been through so much as a health sector and a society in recent months with coronavirus and nothing can take away from the loss and difficulties that we’ve faced but it vital we also don’t disregard the amazing efforts we’v... read more >

health service focus

How NHS Property Services adapted to a new way of working

01/07/2020How NHS Property Services adapted to a new way of working

From May/June 2020 edition Trish Stephen... more >
Cleaner, greener, safer media: Increased ROI, decreased carbon

12/06/2020Cleaner, greener, safer media: Increased ROI, decreased carbon

Evolution is crucial in any business and Nati... more >