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.
At its simplest, commissioning is the process of planning, agreeing and monitoring services. However, securing services is much more complicated than securing goods and the diversity and intricacy of the services delivered by the NHS is unparalleled.
Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.
There is no single geography across which all services should be commissioned: some local services can be designed and secured for a population of a few thousand, while for rare disorders, services need to be considered and secured nationally.
What has changed?
The NHS commissioning system was previously made up of primary care trusts and specialised commissioning groups. Most of the NHS commissioning budget is now managed by 209 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 specialised services, primary care, offender healthcare and some services for the armed forces. It has four regional teams but is one single organisation operating to a common model with one board.
CCGs and NHS England is supported by commissioning support units (CSUs). Their role is to carry out:
- Transformational commissioning functions, such as service redesign; and
- Transactional commissioning functions, such as market management, healthcare procurement, contract negotiation and monitoring, information analysis and risk stratification.
Commissioning of public health services is undertaken by Public Health England (PHE) and local authorities, although NHS England commissions, on behalf of PHE, many of the public health services delivered by the NHS.
Please see the following for more information: