A useful definition of commissioning is that it’s the process of planning, purchasing and maintaining health and care services. Today’s blog will look at all the relevant questions, queries and issues surrounding the commissioning process, new commissioning models and commissioning activities.
Introduced in the early 1990s the concept of commissioning was thought up by the NHS. Reforms were introduced that separated the purchasing of services from their delivery. Commissioning services were introduced with the idea that the competitive processes would encourage competition between providers and thus patients would experience greater efficiency, responsiveness and innovation,
Since that introduction, these arrangements have been altered and changed. The most recent changes were immortalised in the Health and Social Care Act 2012.
There is now a trend for large public bodies to back away from the process of grant-giving with more and more of them opting to award social care contracts through a competitive commissioning process. These providers that compete for the contracts can be private sector companies, charities or social enterprises.
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The process of Commissioning involves a range of different activities, these include:
There is a generally accepted ‘cycle’ that a lot of commissioners follow, this is called the commissioning cycle. The cyclical activity process is usually repeated on an annual basis and part of a long-term plan.
Review – The public body in question (E.g. council or NHS) will take a step back and look at what service(s) needs assessment, the quality of the services’ performance that they’re receiving as well as factoring in any new impacts that may change their needs.
Analysis – After reviewing the current state of play, analysis of needs, policies and resources are done to see where the procurement of new commissioning services is needed and specific outcomes these will bring.
Ongoing Development – The public body will look at the market and determine which private sector company, charity or social enterprise would be best to implement and execute their aims to a high-quality.
Procurement – This is the purchasing of the service, writing forthcoming contracts that will hopefully meet the needs of the public body while also providing the best value for money,
Delivery – The chosen company will then get on with the business of enacting the commissioning function and delivering the services based on the needs, wants and objectives of the public body.
Clinical Commissioning Groups, also known as CCGs were created at the inception of the Social Care Act 2012.
In 2018/2019 CCGs spent a total of £85.4bn out of the total £112.7bn that NHS England spends on the day-to-day running of the service – that’s around 2/3rds of the entire NHS expenditure.
There were initially 211 CCGs in 2013 when it was first established but since then, CCGs have adapted and moulded which is why, as of 1st April 2019 there are 191 CCGs.
A typical Clinical Commissioning Group is made up of people in the care industry, they include GPs and other clinicians like nurses, care consultants, patient representatives, general managers and practice managers and representatives of the local authority.
The group’s stated aim is to get the best possible health outcomes for the local population. This involves a lot of different elements like assessing local needs, performance testing current services, deciding priorities & strategies before purchasing services.
CCGs constantly update and review the services using a dynamic process of consistent, usually annually, planned reviews – this is to keep up with current and future demand and in order for the CCG to target specific duties that need filling and further information needed to create more thorough reviews.
Clinical Commissioning Groups are independent and accountable to the Secretary of State for Health and Social Care through NHS England. They have a great deal of commissioning responsibility because they are essentially responsible for the health of their respective population which ranges from 100,000 to 1,000,000 though the average is 250,000.
In some ways commissioning has stayed the same, the introduction of commissioning along with the Health and Social Care Act 2012 under the coalition Government was designed to give GPs a greater role, at the forefront of deciding how best to look after the general population – this has pretty much stayed the same. However, the way commissioning is delivered has changed since and is continuing to do so.
There has been a proposition by NHS England and NHS Improvement to support news ways of working but currently, there are no proposals being put towards parliament.
Key legislative changes include greater delegation of responsibilities from national to local with a greater focus on joint working between commissioning organisations, commissioners and providers. All of this supports the development of integrated systems of care, including, but not limited to, an increasing focus on ‘population health’ based approach which looks at how best to use local resources.
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