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

Two NHS trusts spent a third of the year on highest ‘Opel 4’ pressure alert

12/12/2018Two NHS trusts spent a third of the year on highest ‘Opel 4’ pressure alert

Two NHS trusts spent more than a third of the year under extreme pressure and on the highest level of alert. An investigation by the BBC fou... more >
Financially struggling NHS trust appoints fifth chief executive in just five years

12/12/2018Financially struggling NHS trust appoints fifth chief executive in just five years

The financially troubled West Hertfordshire Hospitals NHS Trust has appointed Christen Allen as its newest chief executive – marking its fi... more >
Quarter of trusts spent no money on cyber security last year as NHS’s ‘alarming’ cyber training inconsistencies revealed

12/12/2018Quarter of trusts spent no money on cyber security last year as NHS’s ‘alarming’ cyber training inconsistencies revealed

One in four NHS trusts in England and Wales are spending no money on specialist cyber security or training and trusts are consistently failing to... more >
681 149x260 NHE Subscribe button

the scalpel's daily blog

The robots are here at East Suffolk and North Essex

12/12/2018The robots are here at East Suffolk and North Essex

Lauren Hockney, senior communications officer at East Suffolk and North Essex NHS FT (ESNEFT), outlines how her trust is embracing the digital and automation revolution. Robots have arrived at the ESNEFT, and they are giving back hundreds of hours to staff so they can spend more time helping patients. The trust, which includes Colchester and Ipswich hospitals and seven community hospitals in Suffolk and North Essex, is the first in... more >
read more blog posts from 'the scalpel' >

interviews

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 >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... 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

National Health Executive fuels the Northern Powerhouse with official partnership

21/11/2018National Health Executive fuels the Northern Powerhouse with official partnership

Cognitive Publishing, the home of leading hea... more >
Rules of engagement

01/10/2018Rules of engagement

Using technology to increase patient engagement... more >