NIHR POLICY RESEARCH UNIT IN HEALTH AND
SOCIAL CARE SYSTEMS AND COMMISSIONING

Summary of the seminar on healthcare commissioning

20 February 2013

On February 19th the Policy Research Unit in Commissioning and the Healthcare System organised a seminar on health services commissioning. The aim of the seminar was to discuss current commissioning policy in England including:

  • Current policy developments
  • Early findings from the national research programme on Clinical Commissioning Groups
  • A view from the front line
  • Performance and governance issues

The day was attended by 50 researchers, Department of Health representatives and practitioners. During the day there were presentations that covered a range of policy and issues and evidence related to different aspects of healthcare commissioning. Download photos [pdf] >>

Professor Stephen Peckham (Director of PRUComm) started by introducing PRUComm's research team and its current activity. Download slides [pdf] >>

The first presentation was by Ian Ellis (Team Leader for the Mandate group within the NHS Commissioning Policy and Sponsorship Unit on the NHS Policy & Outcomes Group at the Department of Health) and Pia Clinton-Tarestad (Head of Commissioning Policy and Resources, Commissioning Development, NHS Commissioning Board). They provided an overview of current policy developments and how the different responsibilities of the Department of Health and the NHS Commissioning Board are developing. Download slides [pdf] >>

There then followed two presentations on the development of Clinical Commissioning Groups. First, Dr Kath Checkland (Associate Director of PRUComm) presented the results of PRUComm research on Pathfinder CCGs, highlighting some of the emerging issues that seem to be arising so far. It is based upon the findings of a web-based survey of Pathfinder CCGs, and on the early emerging story from 8 qualitative case studies, the presentation will provide a descriptive overview of the developing situation, in particular illustrating the organisational complexity that seems to be present on the ground. Some of the issues that have arisen along the journey so far will be discussed, alongside those things which have been experienced as problematic and those which have been found to be helpful by those involved. Download slides [pdf] >>

Next Chris Naylor (King’s Fund) and Natasha Curry (Nuffield Trust) presented some initial findings from a project that is tracking six CCGs over three years, involving semi-structured interviews, observations and surveys. The first phase is exploring the internal dynamics of CCGs and the relationships that are developing between the CCG leadership and GP members. A particular line of enquiry is the role of the CCG in supporting and monitoring improvement in general practice and how that role might develop alongside the NHS Commissioning Board’s Area Teams. The presentation described, and presented early findings from, the first year of this project. Data collection is ongoing so the findings reflected on key themes that have emerged in interviews and observations already completed. A publication documenting the findings from the first year of the project is planned for Summer 2013. Download slides [pdf] >>

In the afternoon we had three presentations that examined different aspects of commissioning. Professor Rod Sheaff (University of Plymouth) presented findings from an ongoing study that is examining governance mechanisms utilised by commissioners. Different commissioners apply different combinations of six methods of control ('media of power') for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. He presented findings providing a comparison of English and German healthcare commissioners do this. The results were based on a systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources. The comparison exposes and contrasts two basic generic modes of commissioning:

  1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers.
  2. Case-mix commissioning (Germany), in which managerial performance, an 'episode based' negotiated order and juridical controls appear the dominant media of commissioner power.

He argued that governments do not necessarily maximise commissioners' power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners' use of provider competition as a means of control. Download slides [pdf] >>

Dr Lesley Wye (Centre for Primary Care at the University of Bristol) presented preliminary results from one of the threads of a three year study exploring knowledge exchange between external providers (both commercial and not for profit) and clinical commissioners. This focused on the introduction of a risk prediction tool and commissioning decision making around avoidable hospital admissions. Although this was one story of many, it illustrated findings on the role of external providers, the 'knowledge' that is on offer and the approach of clinical commissioners to information, both research based and from other sources. Download slides [pdf] >>

Finally Dr Erica Gadsby (Research Fellow at the Centre for Health Services Studies at the University of Kent and researcher with PRUComm) presented the findings of a recent review of international evidence on personal budget-type programmes in health and social care, and looked at where the English programme sits in relation to others around the world. It examined the key motivations behind such programmes, and what the evidence and wider literature says about the extent to which Personal Budget programmes meet expectations. Download slides [pdf] >>

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