Strategic and Commissioning in Health Care: A Contemporary Approach

STRATEGIC AND COMMISSIONING

Table of Contents
Introduction......................................................................................................................................1
Strategic Commissioning.................................................................................................................1
Strategic Commissioning Framework.............................................................................................5
Purpose, values and strategic objectives of NHS England Strategic Commissioning plan.........8
Priorities for NHS England..............................................................................................................9
Involving patients, public and partners in developing a whole system vision..........................11
Approach to delivering transformation......................................................................................12
Conclusion.....................................................................................................................................16
References......................................................................................................................................18

LIST OF FIGURES
Figure 1: IPC Commissioning Framework......................................................................................2
Figure 2: Model of Care..................................................................................................................7
Figure 3: Future Map.....................................................................................................................11
Figure 4: Areas for Excellence for Warrington.............................................................................13
Figure 5: Acuity and Complexity Model.......................................................................................15

INTRODUCTION
In general, strategic commissioning can be defined as the planning and delivering
services and support for people in a new manner. However, it consist of identifying the needs of
individuals and communities so as to enable people in deciding what will be best for the needs
and expectations. Over the past decade, the role of commissioning, as a key driver of quality,
efficiency and outcomes for patients, has become increasingly important to the health system in
England. The NHS commissioning system was previously made up of primary care trusts and
specialized commissioning groups. Most of the NHS commissioning budget is now managed by
211 clinical commissioning groups (CCGs). These are groups of general practices which come
together in each area to commission the best services for their patients and population.
Nationally, NHS England commissions specialized services, primary care, offender healthcare
and some services for the armed forces. It has 27 area teams but is one single organization
operating to a common model with one board. In the present research report, researcher focuses
on exploring the range of contemporary approaches to strategic commissioning within the health
care environment.
STRATEGIC COMMISSIONING
In general, strategic commissioning refers to the process of specifying, securing and
monitoring services to meet people’s needs at a strategic level. However, this applies to all the
services, whether they are provided by local authority, NHS or other public agencies or by
voluntary sectors. Further, strategic commissioning consist of four crucial stages: to analyse,
plan, deliver and review (Ozcan, 2005). In other words, commissioning is essentially
transformational and not just transactional. It is all about developing and shaping the capacity
within the communities, markets and individual lives that will assist or support the citizen in
meeting their needs and aspirations regardless of age and disability.
Improving commissioning has been one of the major focus of many government
publications if considering the past few years. However, this consist of Our Health, Care, and
Our say, Putting People First, Strong and Prosperous Communities, Health Act etc. Further, in a
published commissioning framework for health and well-being which mainly focuses on the
perspective of whole health and care economy within the context of reforming systems to meet
the needs of individuals. In this regard, strategic commissioning for health and care sector aims
at:
1

 To place people at the centre while focusing on commissioning.
 To identify and understand the needs of population as well as of individuals.
 Making optimum utilisation of available information as well as sharing them properly.
 Assuring quality in provision.
 Promote wellbeing within the workforce.
 Enhancing partnership working and improving the use of flexibilities and joint budgets.
 Creating single health care vision (Bovaird, Briggsand Willis, 2014).
 Enhancing the capabilities and leadership skills.
Furthermore, IPC commissioning framework is considered to be the most common
framework which consist of four key activities in the cycle of commissioning. However, it
emphasises on making sure that all four elements of the cycle such as: analyse, plan, do and
review are in sequence and of equal importance. Therefore, commissioners and contractors
should spend equal time, energy and attention on these four elements. It concentrates that
commissioning process should be equitable and transparent in nature to all the stakeholders.
Figure 1: IPC Commissioning Framework
(Source: Glasby, 2012)
In context to NHS England, it is responsible for the direct commissioning of services
outside the remit of clinical commissioning group which mainly consist of primary care, public
health, offender health, military and veteran health and specialised services. Along with this,
there are some CCGs which have been fully delegated towards the responsibility for
commissioning and contract management of primary medical care.
2

The CCGs contribution in reducing the health inequality gap is addressed by tackling
some of the lifestyle issues and causes of premature death that are identified in JSNA.
Furthermore, CCG has prioritised in improving access to cardiological services, enhancing
diabetic services and refining stroke care, all these are contributing in minimizing the mortality
form of cardiovascular diseases. Moreover, it has also prioritised in improving the psychological
input to alcohol services as well as supporting council in addressing the childhood obesity.
Commissioning priorities that are directly link to the JSNA:
Children’s
services
Improving
Urgent Care
Primary Care
Mental Health
Improving care
for older people
Improving
diabetes
services
Reduce childhood
obesity
Reduce trend in
emergency
impatient
admission
Improving care
of 1 in 4
England people
suffering with
self-reported
poor mental
health
Reduce in
safeguarding
incidents and,
Minimizing
pressure ulcers
Reducing the
level of
undetected
dibatetes
Improving
Access to
cardiology
Ophthalmology
pathway
Improving
stroke care
Community
nursing
services
Alcohol
services
Reduce
cardiovascular
disease mortality
Improve access
to
ophthalmology
services
Reduce in
mortality rate
from stroke
Improving care
to people with
limiting long
term illness,
health problem
or disability
Reduce
emergency
admission linked
to alcohol from
209.5 per
100000.
Primary care strategy Prioritisation of resources
Minimizing unwarranted variation in
performance
Improving productivity to achieve financial
sustainability
3