Strategic commissioning: what the future holds

Julie Wood, chief executive of NHS Clinical Commissioners, looks at how the clinical commissioning landscape will change in the future after having come a remarkably long way in a short space of time.

There is no doubt that we are in a time of change when it comes to how health and care is commissioned.

Since their inception in 2013, CCGs have been evolving and finding better, more collaborative ways of working.

They are continuing on this journey and playing key roles as architects of the changing health and care landscape. This was evident in our recent analysis, ‘Steering towards strategic commissioning.’

How the landscape is evolving

This analysis, informed by a survey and in-depth interviews with our members, revealed that CCG leaders are embracing new ways of working, with 77% of those surveyed intending to contract for a new care model in 2017-18 and 72% planning on increasing their collaborative commissioning.

It also showed that there were four ways in which the local commissioning landscape is evolving:

  • CCGs operating across larger footprints as strategic health commissioners using sustainability and transformation partnerships (STPs) as a key vehicle for delivery;
  • Integration of healthcare commissioning with local authorities;
  • Developing an accountable care system (ACS);
  • Developing integrated delivery models such as accountable care organisations (ACOs).

Above all, it really brought out that CCGs are absolutely seeing strategic commissioning as the way forward to transform the NHS for the better and support improved care for patients.

Defining strategic commissioning

Strategic commissioning has been much talked about, but what it means isn’t necessarily always clear. Essentially, we and our members believe it involves commissioning retaining the strategic functions of managing population healthcare at a local level.

Key elements of this include commissioners acting as high-level decision-making bodies; developing sophisticated approaches to population assessment; remaining accountable to a local population; and working with their providers to allocate capitated budgets for them to deliver agreed health outcomes.

One of the messages that came across most strongly when we spoke about the next phase of commissioning was that strong clinical leadership must remain. To quote our co-chair Dr Amanda Doyle, when the analysis launched, it “reinforces the message that through these changes, strong clinical leadership in commissioning must be preserved to ensure its credibility.”

Clinical leadership has been key to the positive impact that CCGs have brought, and if strategic commissioning is to benefit our patients and populations, it must also be a central element of this.

How do we get to strategic commissioning?

So, our members are agreed that strategic commissioning is the way forward. However, they have also identified that there are some significant risks slowing down the pace of change. To tackle this, we’ve made six asks of national stakeholders to support clinical commissioners.

First among these are clarity on the national direction of travel. For CCGs to evolve, they need to understand the range of ‘end states’ for clinical commissioning – which functions remain and operate at scale and how they interact with those functions more likely to be transacted within an accountable care delivery system.

While the current landscape, perceived as ‘permissive,’ opens opportunities, it also creates risks for CCG governing bodies which are trying to execute their existing functions safely. With the legislative framework looking set to stay static, despite the changing landscape of ACSs, ACOs and STPs, members remain concerned about their statutory accountability.

Learning and transforming

Sharing best practice is another of our asks – CCGs have a really strong appetite to learn from each other and from pioneering ACSs on key issues such as contracting and identifying common pitfalls. A total of 90% of those surveyed reported that they were actively looking for early lessons from the new care models.

Our members also ask to be given time, resource and space to transform, saying they need less burden from centralised reporting so they can confidently plan for the future.

Regulation and managing change

Also among their calls are for a single regulatory framework that mirrors the way that the system has developed, and that when it comes to strategic commissioning is lean and high-level. The pace of change towards ACSs and ACOs have been fast – our members’ confidence in the regulatory framework to catch up is low. 

Providing support for clinical commissioning leaders to manage change was a further ask. While we found that CCG leaders have fairly high morale at present, there are concerns about succession planning and resilience in the context of such large change programmes. Leaders need to be equipped with bespoke skills in keeping resilient and collaborative in changing times.

Finally, CCGs need national support to improve capabilities in areas such as data gathering and analysis, predictive modelling, succession planning and organisational development – all these are essential to enable them to commission for large-scale change.

What next?

Clinical commissioning has come a long way in a very short space of time. It has been continually evolving since the start, with CCGs finding ways to work more collaboratively with each other and with partners across health and care.

There is now clearly much enthusiasm for what the next phase will bring. It is vital that clinical commissioners are given the support they need to make this change and continue their evolution so that, working with partners, they can truly transform the health and care system for patients and populations they serve.



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