Comment

Integrated commissioning: Making a difference

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.