Healthcare delivery and Strategic Commissioning

This report explores the role of commissioning in NHS England and its impact on healthcare service delivery. It also discusses the models and frameworks for procurement and commissioning of healthcare services, patient and public involvement in NHS England, and the gaps in healthcare delivery. The report concludes with the role of leadership in healthcare and the importance of quality standards.

Running Head: Strategic Commissioning
Healthcare delivery and Strategic Commissioning
Report
System04104
3/16/2019

Strategic Commissioning
1
Introduction
Healthcare is known as an ever-progressing system in all over the world. The advancement
and development in the healthcare sector are quite rapid. The new tools and technologies are
developed every day with growing needs of quality healthcare services. To adopt frequent
change according to this rapid growth in the healthcare sector is practically impossible. Thus,
we need to adapt and accept the changes with some strategic plans that meet the challenges of
new diseases in healthcare services (Jones, 2012).
This report is based on the role of commissioning in NHS England. It provides an approach
towards the strategic plan for healthcare organisations. This report shows the impact of
strategic decisions and the role of commissioning in healthcare service delivery. This report
also sheds some lights on the role of leadership in healthcare service delivery and role of
commissioning to determine the standards of service quality.
Role of Strategic Management within the Complex and Challenging
Context of Delivering Health Services
Health care is one of the progressive systems that changes and grows with the rapid growth in
technology and people need. Over the last three decades, types of diseases, cost of care,
public awareness and their participation in treatment, involvement of people in fighting with
some dangerous diseases, and involvement of regulatory bodies in healthcare have all
received the public attention. However, very less attention is given to such changes that
affected the health care quality and control system. The continuous development in the
healthcare delivery system required new standards of care that helps to match the changes in
the healthcare system. Healthcare is a dynamic and continuous developing system that
requires a dynamic and strategic system for its management. The old management by
objectives system is meaningless and not effective in modern healthcare service delivery.
Thus, there is a need for every healthcare organisation to focus on a dynamic management
system.

Strategic Commissioning
2
NHS England and Healthcare
NHS is one of the leading healthcare organisations in England and is known for its strategic
plan in healthcare services. A clear and strategic management plan helps the healthcare
organisation to reduce the cost of service delivery in the healthcare organisation. A good
strategic plan in NHS healthcare organisation helps in ensuring equality of services for the
patients. NHS is known for its healthcare policies and strategies. NHS annually updates its
provision related to healthcare standards because it is the statutory duty in NHS England. To
carry out these changes in the healthcare organisation, NHS spent a huge amount on the
strategic change in delivering healthcare services. The NHS in England uses a wide range of
approach to improve its healthcare service delivery standards and planning a sufficient budget
for healthcare organisations (GOV.UK, 2018). Commissioning plays an important role to
implement these changes in the healthcare organisation. Commissioning is the process of
analysing needs of healthcare organisation and then planning and prioritising these needs by
purchasing and monitoring healthcare services. Healthcare commissioners are appointed in
the NHS England to ensure the standard quality of healthcare services. These commissioners
are also responsible for the quality of care and cost control.
Models and Frameworks relating to procurement and Commissioning
of Healthcare Services in NHS England
There are different models under CCG (Clinical Commissioning Groups) which helps in
procurement and commissioning of healthcare services. Healthcare commissioners are
responsible to ensure that sufficient and standard services are provided to the patients (Field,
and Oliver, 2013). Apart from this, some model helps in providing appropriate healthcare
services to society at a very low cost. The popular three models in healthcare commissioning
are as follow:
1. Prime Contractor Model
In this model, the CCG contracts with a single healthcare organisation that further contacts
with other sub-contractors for commissioning and procuring healthcare services. The CCG is
responsible for the commissioned services while the prime contractor holds other each sub-
contractor for their accountability. In this model, the prime contractor designs all the delivery
and procurement model and patient pathways that most effectively meet the terms of the

Strategic Commissioning
3
contract. The prime contractor helps the other sub-contractor in the procurement of
healthcare services (Policy, 2013).
(Source: Wenzl, McCuskee, and Mossialos, 2015)
The major disadvantages of prime contractor model for procuring healthcare services are as
follow:
1. It includes high financial risk for the prime contractor.
2. Problem for management
3. Suppliers of the healthcare services may not have sufficient skills for contracting or
commissioning.
2. Prime Provider Model
This model is an extension model of prime contractor model in which the contacted
organisation also delivers care for the healthcare products and services which is the part of
the agreement. Just like prime contractor model, the prime provider of healthcare services
receives sufficient capital budget for all the care mentioned in the contract. The prime
provider can also purchase some new healthcare from the sub-contractors services from this
budget that it cannot deliver directly.

Strategic Commissioning
4
(Source: Wenzl, McCuskee, and Mossialos, 2015)
This model has several drawbacks, which are as follow:
1. Monopoly of Provider
2. May limit patient choice and encourage cream skimming.
3. Suppliers of the healthcare services may not have sufficient skills for contracting or
commissioning.
3. Alliance Contract Model
In this model, the number of providers delivers healthcare services under the CCG by
entering into a single arrangement. Providers and commissioners are lawfully connected with
each other and share common risk and responsibilities in delivery of healthcare services. In
alliance model, there have been heavy incentives to collaborate.

Strategic Commissioning
5
(Source: Wenzl, McCuskee, and Mossialos, 2015)
There are several disadvantages of Alliance contract model, which are as follow:
1. The financial risk and clinical risk depends on the overall performance of providers.
2. It is the most difficult model to manage for a commissioner.
3. Requires strong trust and a strong relationship
4. Governance failure leads to weak leadership and accountability.
Patient and Public involvement in NHS England
In NHS constitution, NHS is committed to its patients and every decision of this organisation
revolves around the patients. NHS is working to develop and improve the involvement of the
public in healthcare services. NHS England is also responsible for developing its business
functions. NHS ensures that all the healthcare facilities can be easily provided to the people
and patients. NHS designed some specialised services for prison health, dental health, and
primary care. The health and wellbeing boards of NHS bring local health commissioners for
public health and social care and deliver the healthcare services under them. The NHS helps
the patients to receive quality healthcare services in every healthcare organisation
(Heginbotham, 2012).
The NHS procurement development plan appointed a private sector procurement organisation
that is an expert in delivering healthcare services. The focus of this procurement plan is to

Strategic Commissioning
6
deliver immediate healthcare services to people with immediate efficiency and productivity
gains. Apart from this, NHS also publishes an E-procurement strategy that helps in supply of
healthcare services to the public. The National integrated programs of NHS not only deliver
superior quality healthcare products but it also improves the outcomes with reduced cost
through clinical procurements. The National integrated programs improve the leadership and
capability of healthcare organisations that further leads to a better healthcare system in the
public. It can be said that the procurement system of NHS always encourages the
procurement organisation to provide the world's best healthcare services to the patients and
people (Shaw, et. al., 2013).
Impact of Commissioning on key stakeholders in Healthcare
In a healthcare organisation, all the people who are involved in any activity in healthcare are
called stakeholders. There are many stakeholders in healthcare and social care organisation.
The key stakeholders are healthcare organisations, patient an caregivers, family and patients,
facilitators, staff, and some care quality commissions. Commissioning in healthcare impacts
these all stakeholders because it plans and observes various activities in healthcare that are
related to these stakeholders. Commissioning helps in procuring and delivering various
healthcare products and services to the patients at minimum cost (Janamian, Jackson, and
Dunbar, 2014).
According to the views of patients, the quality of healthcare services totally depends on the
healthcare organisation that provides various facilities to its patient. However, behind this,
the role of commissioning is so crucial that determines the quality of services. Apart from
this, Commissioning helps in providing better training to the healthcare staff and nurses to
provide the best service quality to the patients (Chambers, et. al., 2013). NHS England
always takes care of the interest of its stakeholders and ensures that the healthcare
organisation will provide the best healthcare services to the patients without any compromise
with their expectations. However, it has been seen in NHS England that people tend to leave
their jobs when they get better job options which provide them extra earning with other
facilities. This is the major problem in NHS commissioning during ensuring the best quality
services.

Strategic Commissioning
7
Gaps in Healthcare Delivery in NHS and Some Recognized Quality
Standards
NHS is known for its quality healthcare services and it is the primary need of every
organisation, but somewhere it is lacking in providing more facilities to the patients on an
immediate basis. In any healthcare organisation, the quality can be measured in terms of
services that are provided to the patients. Although, it can be said that it is the starting point
of quality. The quality of healthcare services can be achieved on a regular basis to achieve
customer satisfaction. The Gap in healthcare services can be measured in terms of what
services are provided by the healthcare organisation and what is expected by the patient. The
patient always expects a high quality of healthcare services from the healthcare providers
(Peskett, 2009).
Quality is an important factor in healthcare services and it is a major aspect of in the health
services of NHS England. Quality level can be identified at any time when it is not present
during the healthcare services. There are many factors such as waiting times, waiting list,
quality services, and patient treatment procedure and quality that determine the quality of
services in the healthcare organisations. There are numbers of quality assurance standards
that measure the standard of healthcare organisations.
Total Quality Management (TQM)
TQM was firstly introduced by Japan almost 35 years back. TQM is a famous quality
management system used by a number of countries because it is a widely accepted quality
assurance technique in all over the world (Mosadeghrad, 2013). TQM is also used by NHS
and it proved to be an excellent system to measure the quality of healthcare services,
decreasing the cost of services, helps the organisation in concentrating on customer needs,
and satisfy the customer needs. TQM involves every staff to provide quality services to
patients (Humphries, 2015). NHS England uses the TQM to analyse the different external and
internal factors that influence and affect the organisation and its operations. TQM approaches
strict and standard practices for service development, provide valuable services, waste
reduction, and commercial optimization. Apart from this, NHS takes help of Quality
Assurance (QA) in documentation and administrative processes.

Strategic Commissioning
8
Care Quality Commission (CQC)
The care quality commission is a self-regulatory organisation that ensures that a patient will
get quality healthcare services in terms of safe and secure healthcare products and services
(CQC, 2018). The CQC makes sure that patient will be provided effective and best quality
care with improvement. CQC helps in both determining the quality of healthcare services and
disclose information and records related to performance ratings of healthcare organisations
(Blake, Sparrow, and Field, 2015).
NICE Quality Standards
This quality standard was formulated in 2009, which is adopted by NHS England to ensure
superior quality services to the patients. It was formulated by the Health and Social Care
Directorate that is helpful in government programs ‘NHS and Social care system'. NICE has
high priority areas for improvement in healthcare service quality. Each standard and
measures of this quality standard are based on evidence-based guidance. NICE helps the
healthcare organisation to identify and improve the weak area in healthcare services (Leng,
2012).
Service Delivery and the role of Leadership in Healthcare
Effective governance plays a vital role in the effective management of care in healthcare
organisations. Clinical leadership is really one of the important factors in healthcare. A leader
can guide and motivates the healthcare staff to give their best to the patient, thus they can feel
safe and secure during treatment. Although, in the modern era the people are more aware of
the health-related aspects and using a different source of knowledge for accessing
information. Thus, it is the responsibility of a leader to train every people in the healthcare
organisation to raise the standard of healthcare qualities and standards (Kahveci, et. al.,
2018). Therefore, the role of a leader is increased in any healthcare organisation that monitors
every activity in the organisation. It is also noticeable that now the healthcare leader is not
only responsible for better healthcare facilities rather also responsible for government bodies.
It is the responsibility of a healthcare leader to analyse every aspect of healthcare services
and ensures that no one doing fraud with the patients. The leader should also ensure that
people would get expected benefits and services from healthcare organisations.

Strategic Commissioning
9
Conclusion
In the end, commissioning plays an important role in determining the quality and standards of
healthcare services. NHS England works closely with various health care organisations to
provide and commission a range of public healthcare services. The various commissioning
policies are part of NHS England for some specialised and non-specialised services. The
healthcare commissioning ensures safe and secure healthcare services to its patients and
provides facilities to various procurement agencies to deliver healthcare services to the
people. Although, Commission is helpful in determine best healthcare services, but there are
few other quality standards also exist in the healthcare sector that creates conflict with
Commissioning. Thus, it is difficult to establish coordination between commissioning and
different healthcare quality standards.

Strategic Commissioning
10
Development Plan
Developing a strategy for a healthcare organisation is not an easy task rather it requires a full
understanding of current market challenges, great analysis of customer needs and satisfaction,
evaluation of current healthcare operations, analysis and assessment the quality of current
healthcare services (Shapiro, 2014). Strategy starts with setting the organisational mission
and vision statements. The very first step is to set a vision. Vision is a point where an
organisation wants to be at the said time driven by some organisational values. These values
cover the set the accountability of every person, customer-driven services, continuous
improvement in the services, and good quality services provided to the users. This
development plan includes five phases under the cycle of Plan, Do, Check, and Act (PDCA).
(Source: Wargo, 2016)

Strategic Commissioning
11
Plan
Phase –I
This phase includes gathering data from different sources as feedback about the
organisational failure activities such as customer complaints, employee's negative feedback,
complaints about service quality, stakeholder remarks, process failure etc. This information is
helpful in understanding the current business-related aspects of healthcare and shows a clear
status of an organisation that how the organisation is performing. It also highlights the
weakness and strength of the organisation.
Phase-II
In the second phase of the strategic development plan, leadership go through various policies
that help to encounter the problems that were raised by customers, employees, and other
stakeholders in the first phase. The second phase is totally related to Policy Deployment (PD)
where management creates a structure through which organisation can achieve its objectives.
The duration of the strategic plan is should not be longer than 5 years. PD process can be
started with listening to the problems of every manager and ask him or her to prepare a report
for the problems they found in the organisation and then implement several policies that
determine formulation of the organisational objective.
Do
Phase-III
The result of policy deployment not only helps in setting the organisational objective but it
will also contribute and expressed in other healthcare activities and improvement activities.
The phase three will describe who will do what, by when and for what purpose, and how it
can be related to the organisational objective.
Check
Phase-IV
The management of the healthcare organisation aimed at the following activities under Check
process:
1. Determine various activities that will be focused on selected themes.

Strategic Commissioning
12
2. Remove the un-necessary activities
3. Continuous encouragement of management to the staff in the organisation and
demonstrate full support and encouragement.
4. Only access the logical data and do not spend too much time on irrelevant or illogical
data. It means to check the authenticity of information and data.
5. Extract the learning and organise it in such a way that helps the system.
Act
Phase-V
In the final phase, healthcare management reviews the feedback and data collected in various
processes during the various phases. Management can also assess the progress by analysing
the process improvements efforts. The management in the healthcare organisation also
accepts or reject any recommended changes based on the results. The accurate and factual
data collected in various phases will help the management to make decisions about bringing
any modification or changes in the current healthcare operational system.
Summary
The strategic development phase in any healthcare organisation is started with setting mission
and vision. However, assessment of current healthcare operational system is the key of
evaluating and analysing the organisational performance. Further, it helps in setting
objectives. The data gathered in various phases helps in assessing organisational strength and
weakness. The collected data from different sources through PD will be of great value in
shaping the future image of the organisation.

Strategic Commissioning
13
References
Blake, A., Sparrow, N., and Field, S. (2015) Care Quality Commission. InnovAiT: Education
and inspiration for general practice.
CQC. (2018) The Independent Regulator and Social Care in England. [online]. Available
from: https://www.cqc.org.uk/about-us/our-purpose-role/who-we-are [Accessed 25-06-2018].
Field, R. and Oliver, J. (2013) Effective Commissioning in Health and Social Care. Learning
Matters.
GOV.UK. (2018) Health and Safety. [online]. Available from:
https://www.gov.uk/government/policies/health-and-safety-reform [Accessed 25/06/2018].
Heginbotham, C. (2012) Values-based commissioning of health and social care. UK:
Cambridge University Press.
Humphries, R. (2015) Integrated health and social care in England – Progress and
Prospects. [online]. Available from: https://www.healthpolicyjrnl.com/article/S0168-
8510(15)00117-7/pdf [Accessed 19/03/2019].
Janamian, T., Jackson, C.L. and Dunbar, J.A. (2014) Co-creating value in research:
stakeholders' perspectives. The Medical journal of Australia, 201(3), pp. 44-46.
Kahveci, R., Yasar, I., Ayhan, D., Aksoy, H., Meltem, E., Ozkara, K.A. (2018) Comparison
of Quality and Content of Violence Guidelines For The Health Care Sector. Journal of
Clinical and Experimental Investigations, 9(1), pp. 51-57.
Leng, G. (2012) A ‘new’ NICE for health and social care. [online]. Available From:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954251/ [Accessed 19/03/2019].
Mosadeghrad, A. (2013) Obstacles to TQM success in healthcare systems. International
Journal of Health Care Quality Assurance, 26(2), pp. 147-173.
Peskett, S., (2009) The challenges of commissioning healthcare: a discussion paper. The
International journal of health planning and management, 24(2), pp.95-112.
doi:https://doi.org/10.1002/hpm.987
Policy, N.C. (2013) Ethical framework for priority setting and resource allocation. Health P,
editor.: NHS commissioning board.
Shapiro, J. (2014) English clinical commissioning groups: how to ensure their first birthday
isn’t their last [online]. Available from: https://www.bmj.com/content/348/bmj.g2306
[Accessed 17/03/2019].

Strategic Commissioning
14
Shaw, S.E., Smith, J.A., Porter, A., Rosen, R. and Mays, N. (2013) The work of
commissioning: a multisite case study of healthcare commissioning in England's NHS
[online]. Available from: https://bmjopen.bmj.com/content/3/9/e003341 [Accessed
17/03/2019].
Wargo, W.F. (2016) The history of infant formula: quality, Safety, and standard methods.
[online]. Available from:
http://www.ingentaconnect.com/content/aoac/jaoac/2016/00000099/00000001/art00003
[Accessed 17/03/2019].
Jones, R., (2012) Time to re-evaluate financial risk in GP commissioning. British Journal of
Healthcare Management, 18(1), pp.39-48.
Chambers, N., Sheaff, R., Mahon, A., Byng, R., Mannion, R., Charles, N., Exworthy, M. and
Llewellyn, S. (2013) The practice of commissioning healthcare from a private provider:
learning from an in-depth case study. BMC health services research, 13(1), p.S4.
Wenzl, M., McCuskee, S. and Mossialos, E. (2015) Commissioning for equity in the NHS:
rhetoric and practice. British medical bulletin, 115(1), pp.5-17.