Most definitions of commissioning paint a picture of a cycle of activities at a strategic level - concerned with whole groups of people - including:
- assessing the needs of a population;
- setting priorities and developing commissioning strategies to meet those needs in line with local and national targets;
- securing services from providers to meet those needs and targets;
- monitoring and evaluating outcomes; and
- the above combined with an explicit requirement to consult and involve a range of stakeholders, patients/service users and carers in the process.
However, commissioning does not happen just at this strategic level by local authorities and PCTs; there is a continuum of commissioning activity that runs across the health and wellbeing system as illustrated below. There is not a single ‘ideal’ location for commissioning all services. The task is to decide what is the most appropriate level to achieve the required outcomes, and hence the specific local commissioning configuration i.e. where to allocate the responsibility for carrying out particular commissioning activities in the North West.
The continuum of commissioning levels
Source: Adapted from Smith1 et al, 2004, p6
The leadership in the North West have recognised the following emerging commissioning levels in the health and wellbeing system.
Individual level – commissioning at this level may be done by the individual, a family carer, an independent broker, a care manager or a combination of these. It is the government’s intention that service users and carers themselves should increasingly assume the lead role in commissioning services to meet their own individual needs and aspirations. The planned expansion of self-directed support via direct payments and individual budgets will require fundamental changes to the present system of assessment and care management and will impact on the strategic commissioning role.
Locality level – increasingly commissioning responsibilities and activities are being devolved to a locality level via practice-based commissioning for local health budgets, and schools-based as well as locality adult community care commissioning. As more commissioning decisions are be made at practice, not PCT, level, joint commissioning arrangements and links with localities may need to be reassessed.
Community level – traditionally PCTs and local authorities have determined how to make the best use of available resources on the basis of population needs assessments and evaluating existing services, past performance and notable practice elsewhere. However, the role of strategic commissioning will need to change to reflect the increasing importance of individual and locality commissioning as well as the responsibility to develop the market for the whole community by leading and coordinating the activities of different agencies.
Regional/sub-regional level – the more specialist the service and the lower its volume, the higher the level at which it is most appropriately commissioned. Some complex and acute needs will often be most effectively met when local authorities, PCTs and/or strategic health authorities work together, maybe pooling top sliced budgets.
Procurement is not the same as commissioning, although you may hear the words used interchangeably. Procurement, purchasing and contracting are activities that focus on a specific part of the wider commissioning process – the selection, negotiation and agreement with the provider of what service is to be supplied. Procurement or purchasing usually refers to the process of finding and deciding on a provider. Contracting usually refers to the negotiation and letting of a contract and its subsequent monitoring.
Click here for the North West glossary of commissioning related terms and their meaning and the North West commissioning principles, both of which have been endorsed by regional leadership.
Benefits of commissioning
Commissioning, undertaken effectively, has the potential to help in the improvement of services. It is a tool that can help with:
- Understanding long term demand, giving a common perception of the world amongst partners.
- Understanding the best approaches and methods for meeting that demand and hence improving and modernising services to achieve better outcomes.
- Making decisions that are transparent and fair.
- Encouraging innovative service solutions by providers.
- Achieving best value by better configuration of services and increased efficiencies.
- Influencing the market by clarifying the longer term purchasing intentions of the commissioners.
1J. Smith et al (2004). A review of the effectiveness of primary care-led commissioning and its place in the NHS. London, the Health Foundation.
