One of the main focusses of the Health and Social Care Act 2012 (implemented from 2013) was on the development of Clinical Commissioning Groups (CCGs) to replace Primary Care Trusts (PCTs) in commissioning healthcare for their local populations. This report presents the findings from a second phase of our ongoing study following the development of CCGs in England since 2011.
In the first phase of this study (January 2011 to September 2012), we followed the development of CCGs from birth to authorisation i.e. from their involvement in the ‘pathfinder’ programme and officially becoming sub-committees of their local PCT Cluster until their authorisation in April 2013. One of the issues highlighted by our participants in the first phase of the study was the perception of GP ‘added value’. The aim of the second phase of our study was therefore to follow up those claims made in the first phase around issues of GP ‘added value’. We explored further the potential added value that clinicians, specifically GPs, bring to the commissioning process in interviews, and followed this up with observations of commissioners at work.
Our research used ‘Realist Evaluation’ (Pawson & Tilley, 1997). This approach involves: seeking out participants ‘programme theories’ as to how a particular policy or programme will bring about the desired outcomes; exploring the extent to which these programme theories ‘work’ in the real world; and examining in detail the mechanisms and contexts which underpin them. The
approach is often said to be exploring ‘what works, for whom, in what circumstances’? We applied this approach to GPs roles in CCGs, using interviews to find out what CCG leaders believe are the key aspects of their contribution to commissioning. We then observed a wide range of meetings in order to explore the extent to which the claims they made were borne out in practice, and to try to elucidate the important conditions which supported their roles.
As part of the Health and Social Care Act 2012 (Secretary of State 2012) significant changes to the public health system were introduced. Such changes included: the creation of a new national public health service, Public Health England (PHE); a restored emphasis on the role of general practice in health improvement (DH 2010); the transfer of public health responsibilities from Primary Care Trusts (PCTs) to local authorities; and the creation of Health and Wellbeing Boards (HWBs) as committees of each unitary and upper-tier local authority, where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. As a result of the new arrangements, responsibility for commissioning and delivering public health activities are now split between a number of organisations, including: local authorities, general practice, PHE, NHS England (NHSE) (formally called the NHS Commissioning Board), and voluntary organisations. This potentially means a more complex commissioning and service delivery environment for public health than previously (DH 2011a, DH 2011b).
The PHOENIX project aims to examine the impact of structural changes to the health and care system in England on the functioning of the public health system, and on the approaches taken to improving the public’s health.
This second interim report presents the findings of our phase one case study research and first national surveys of Directors of Public Health (DsPH) and Councillors who lead on public health issues. Download report [pdf]>>
The first national surveys report can be found here.
Since 1998, The University of Manchester has undertaken regular surveys of the perceptions of GPs in England about their working lives. These surveys provide important independent evidence for the Department of Health, which contributes to informing policy around GP retention and recruitment.
The results of the 8th National GP Worklife Survey are published today. The survey was undertaken in the spring and summer of 2015 and responses were received from over 2,600 GPs.
The respondents reported the lowest levels of job satisfaction since before the introduction of their new contract in 2004, the highest levels of stress since the start of the survey series, and an increase since three years ago in the proportion of GPs intending to quit direct patient care within the next five years.
The survey was carried out by the Manchester Centre for Health Economics in the Institute of Population Health, on behalf of the Policy Research Unit in Commissioning and the Health Care System (PRUComm), and the report is available here (PDF 784KB).
Over the last year PRUComm’s research activities have continued to expand culminating in a new phase of work examining co-commissioning of primary care by CGGs and NHS England and additional short research projects on primary care to include new projects on the public health system in England and research on competition and collaboration. We have also continued our research on aspects of the functioning of the health care system with work on contracting and competition and also continued to examine the developing public health system. This is our third annual review of research and provides a brief overview of our current research activities.
This three year project aimed to investigate how commissioners negotiated, specified, monitored and managed contractual mechanisms to improve services and allocate financial risk in their local health economies, looking at both acute services and community health care.
Thursday 26 March 2015, 10am - 4pm
George Fox Suite, Friends Meeting House, Euston, London
In England, policy piloting has become firmly established in almost all areas of public policy and is seen as good practice in establishing ‘what works’. However, equating piloting with evaluation can risk oversimplifying the relationship between piloting and policy-making.
Using three case studies from health and social care – the Partnerships for Older People Projects (POPP) pilots, the Individual Budgets pilots and the Whole System Demonstrators (WSD) – the paper identifies multiple purposes of piloting, of which piloting for generating evidence of effectiveness was only one. Importantly, piloting was also aimed at promoting policy change and driving implementation, both in pilot sites and nationally. Indeed, policy makers appeared to be using pilots mainly to promote government policy, using evaluation as a strategy to strengthen the legitimacy of their decisions and to convince critical audiences. These findings highlight the ambiguous nature of piloting and thus question the extent to which piloting contributes to the agenda of evidence-based policy-making.
Full paper can be accessed from Journal of Social Policy
This report summarises the findings of a rapid review undertaken by PRUComm of the available evidence of what factors should be taken into account in planning for the closer working of primary and community health/care services in order to increase the scope of services provided outside of hospitals. This report was commissioned by the Department of Health to provide background evidence to support policy development on primary and community health care integration.
This is a review of the literature on primary care physician (Eg family doctor, general practitioner or other generalist working in a community setting) payment, methods and their impacts on physician behaviour. This report was commissioned by the Department of Health to provide background evidence to support policy development on primary care and the impact of payment structures.
By Anna Coleman and Julia Segar, Originally posted by
A recent publication by the New Local Government Network (NLGN) looked at how local councils are preparing for the future and suggests depressingly that“there is simply no way that local government can reach 2018 let alone 2020 while still delivering the full range and quality of services currently on offer”(p6).
Simply put, we have an ageing population, with associated increasing demand for care services and draconian cuts in council budgets. The NLGN suggest we could be facing a future of “private affluence and public squalor”. However, it is not all doom and gloom. Perhaps austerity can be a strong stimulus for innovation? How would this work I hear you ask?
- Apr 2020: Commissioning Healthcare in England - Book Launch
- Nov 2019: Integrated Care Systems: What can current reforms learn from past research on regional co-ordination of health and care in England? A literature review
- Jan 2019: National evaluation of the Vanguard new care models programme. Interim report: understanding the national support programme
- Nov 2018: Understanding the new commissioning system in England: contexts, mechanisms and outcomes
- Nov 2018: Investigating recent developments in the commissioning system
- Jul 2018: Impact of removing indicators from the Quality and Outcomes Framework
- May 2018: Numbers of GPs who want out within 5 years at all-time high
- Mar 2018: Understanding primary care co-commissioning: Uptake, development, and impacts. Final report
- Mar 2018: Planning and managing primary care services - Lessons from the NHS in England
- Mar 2018: PRUComm Annual Research Seminar [Event]
- Mar 2018: PRUComm Annual Research Seminar [Event]
- Apr 2016: The future of commissioning [Event]
- Mar 2016: Examining the impact of the Health & Social Care Act: Examining developments in the English health system from 2013-2015 [Event]
- Feb 2013: Healthcare Commissioning Seminar: A summary
- Feb 2013 PRUComm research seminar on healthcare commissioning [Event]
- Jun 2011: How can evaluation contribute to health policy in England? [Event]