Future of commissioning

Commissioning is the process of planning and purchasing health and care services to ensure they meet the needs of the population. Carried out by local clinical commissioning groups (CCGs) and the national specialised services commissioner NHS England, it is a complex process which through careful planning and monitoring of services aims to improve outcomes and ensure high quality care.

For commissioning to be effective, NHS Providers believes there needs to be a move away from short-term transactional and efficiency-driven approaches towards more strategic service design focused on understanding the health needs of the population and working in collaboration with local providers.

The specialised commissioning landscape

There is on-going debate about the best strategy to pursue in commissioning specialised provision. Providers are facing challenging efficiency requirements for specialised services. We are therefore working with NHS England and other stakeholders on the immediate contractual and operational pressures as well as the longer-term future for specialised services from 2016/17 and beyond.

NHS England has now established arrangements to co-commission some services, including primary care, in partnership with CCGs and has undertaken a number of individual reviews of specific specialised services.

In 2015 NHS Providers helped establish a ‘system leaders’ group on specialised commissioning to help shape the future direction of specialised services at a strategic level. This has helped to ensure appropriate engagement with all relevant parts of the service: commissioners, providers, patients and the public, and has facilitated discussion of issues such as the development of co-commissioning and the consequences of changes to the national tariff.

To find out more or provide views and feedback on any of the issues relating to specialised commissioning, please contact Edward Cornick
 or Miriam Deakin.

CCGs and the introduction of co-commissioning

CCGs were established on 1 April 2013 and are clinically-led statutory bodies that commission local healthcare services. There is no doubt that the development of constructive working relationships between providers and their local commissioners is central in ensuring collaborative integrated working across a local health and social care economy, including through the process of sustainability and transformation planning.

Following principles set out in the NHS Five year forward view, and described in detail in Next steps towards primary care co-commissioning,from 1 April 2015, over 70 per cent of CCGs took on greater commissioning responsibilities for GP services. Joint commissioning is one of three models now offered to CCGs. It enables one or more CCGs to assume responsibility for jointly commissioning primary medical care services with NHS England, either through a joint committee or ‘committees in common’.

We are interested in member feedback on building constructive relationships with CCG partners, as well as on particular challenges or contracting issues (see below). We also remain conscious of the logistical challenges the commissioning structure presents for colleagues across the health and care sector, particularly when NHS providers need to report to a large number of individual CCGs with differing priorities and work with a number of Health and Wellbeing Boards.

The contracting round 2016/17

The NHS budget is confirmed annually, but providers and commissioners are required to create multi-year plans, while new national priorities can be imposed mid-year without adequate funding or integration with existing priorities. This process can divert money away from patient care through the increased costs generated from re-negotiating service contracts every year, and can create pressures on both commissioners and providers.

This year's contracting round was once again demanding for NHS providers and commissioners, with delays to the publication of the standard contract and negotiations on the tariff meaning that financial planning has been difficult, with many provider and commissioner contracting teams still far from agreeing contracts as we entered 2016/17.

We will be working with our members and stakeholders including NHS England and CCGs to try and resolve the issues this creates, and ensure lessons are learned so that in the future providers are given the opportunity to create more stable plans that allow them to deliver the best possible patient care. To find out more please see our contracting page and to provide views and feedback on any of the issues relating to contracting please contact Edward Cornick.

Devolution

The Treasury and local authorities in Manchester have agreed to devolve decision making and funding for a range of public services in Greater Manchester. The agreement includes a focus on health and social care and is designed to facilitate integration and support transformational changes to the way services are delivered across the area.

A number of other regions registered devolution bids with the Department for Communities and Local Government. A proportion of these include a health and social care element and some are now developing plans to take over their local budgets for health and care provision to improve services for patients.

For further information on devolution in Greater Manchester, click here.

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