With the advent of practice-based commissioning and the World Class Commissioning initiative, commissioning is now a key NHS activity. PBC has created over 1,000 health economies, each with its own agenda for change. World Class Commissioning will build a whole new world linking commissioning to health outcomes like never before.

To maximise your opportunities in this fast-moving environment, you need to have insight into the actual action plans of PCTs and clusters. Only then will you be equipped to exploit openings to influence healthcare professionals as they strive to deliver more effective healthcare.

This first article in a series from the National Health Intelligence Service (NHIS) at www.nhis.info sets the scene. Subsequent articles will get behind the generalities to see how some of these local economies are thinking and planning, using extracts from the NHIS datasource.

Commissioners are destined to become the local leaders of the NHS. You will only reach your full potential if they are also your partners.

The New Vision

Commissioning in the NHS is the process of deciding what services or products are needed, acquiring them and ensuring that they meet requirements and can be afforded. Commissioners “act on behalf of the public, ensuring they have access to the services they need, not only today but also in the future”.

The new drive is to achieve so-called ‘World Class Commissioning’. This is an aspiration aimed at “delivering outstanding performance in the way that health and care services are commissioned”. By means of this initiative, the Department of Health is “transforming the commissioning health and care services in the NHS to drive unprecedented improvements in patient outcomes”. It has “worked with commissioners and their partners to develop a vision for world class commissioning and a set of 11 organisational competencies”.

The vision “focuses on the importance of assessing and prioritising the needs of the population, strategic outcomes, procuring services, and managing providers to deliver the required outcomes. Central to successful commissioning will be an ability to work in close partnership with all local community stakeholders”.

What it Means

It is interesting that, had Mr. Bevan access to the same managementspeak sixty years ago, he might have articulated the aspiration that the NHS should aim to become a World Class provider of healthcare. Of course, with the experience of the last sixty years, it would be unthinkable that the Department of Health would even begin to consider going down that particular route.

However, because it is widely accepted that the NHS has to continue to undergo change to achieve what Mr. Blair called its “modernisation,” the Department was under pressure to invent some kind of initiative. By focusing on commissioning, it has hit upon an excellent indirect route to try to achieve the goals of both Blair and Bevan, with the added bonus of having a well-defined group of people to blame if things do not go according to plan.

What it means is that commissioning is being elevated from a routine part of the NHS management activity to being the focus of attention. Commissioners have become important people – local leaders of the NHS – who will have to be trained to a very high level of competence, assessed in great detail and have their performance closely monitored over the next few years.

Currently, commissioning takes place at a number of levels within the system. The English PCTs hold statutory responsibilities for healthcare commissioning but many other organisations and individuals are involved in the process. Also, the practice-based commissioning initiative means that a range of professionals working in the community are taking lead roles in making commissioning decisions. Also some specialist commissioning tasks involve inputs from a range of organisations and stakeholders, particularly the Local Authorities.

The Commissioning Cycle

As set out, for example, by South Central SHA, the commissioning cycle is an ongoing process covering planning, execution and management in relation to commissioning, which includes assessing needs, reviewing services and gap analysis, risk management, deciding priorities, strategic options, contract implementation, provider development and mapping provider performance. Its commissioning cycle includes the development, review and approval of three plans:

• The strategic commissioning plan, which establishes each PCT’s direction and priorities for at least the next five years. It is developed every three years and updated annually.
• The operating plan sets out how the PCT plans to achieve the health outcomes and financial goals set out in the strategic commissioning plan. It includes targets, financial and activity schedules and action plans. It is developed annually.
• The organisational development plan describes the organisational capabilities needed to deliver the strategic commissioning plan, identifying any gaps and how they will be filled. It is developed every three years and updated annually.

PCT Boards will work with local stakeholders so that these plans are comprehensive and integrated into local delivery.

The SHA has to ensure that all options are reviewed and financially developed in order to make an informed choice about the future of the commissioning function. What is needed is a way to ensure that plans are rigorous, practical and consistent and that they will improve the health of the local population.

The Competences

Commissioning competencies – see box – cover the “knowledge, skills, behaviours and characteristics that underpin effective commissioning. When put into practice they become capabilities. World class commissioners will secure effective strategic capacity and capability to turn competence into excellence, transforming people’s health and well-being outcomes at the local level, while reducing health inequalities and promoting inclusion.”

Competencies can be “defined, taught, learned, put into practice, tested, observed and quality assured, but they are not an end in themselves. World class commissioners will also display visionary, inspiring leadership. The workforce will be motivated and fully engaged with local people and communities, aware of their needs, addressing them in the most effective ways.”

Practice-based Commissioning

In this new environment, practice-based commissioning will remain a vital link in the commissioning process. The aim is that practice-based commissioners, working closely with PCTs and secondary care clinicians will lead the work on shaping clinical outcomes. They will also play a key supporting role for PCTs by assessing local needs, helping to decide local priorities, designing care and providing valuable feedback on provider performance. But, with commissioning under intense scrutiny, there is likely to be tension between the PCT commissioners and the practicebased personnel since both will have their own agendas. This situation will be exacerbated as more practice-based commissioners get into their stride and refine their own ideas on service redesign.

The End Point

While the short-term aims will be all about the practice of commissioning, with such long-term aims as “transforming people’s health and well-being outcomes at the local level, while reducing health inequalities and promoting inclusion”, Mr. Bevan would be well pleased.