Specialised Commissioning

Within the Direct Commissioning directorate, the Specialised Commissioning team is responsible for planning and buying specialised services. These are services for patients who have relatively rare conditions that need treatment e.g. rare forms of cancer; renal disease; neuro surgery. There are over 130 specialised services The team work with clinicians to develop services or new ways to deliver care for patients that improve health outcomes, are sustainable and reduce variation in the standard of care.

The Specialised Commissioning team are responsible for working with local clinicians to plan and buy specialised health services in the South West. Below is an example of a recent programme looking at neonatal services in the Bristol, North Somerset and South Gloucestershire area.

Neonatal services – Bristol, North Somerset and South Gloucestershire

Specialised commissioners and a project team from the two Neonatal Intensive Care Units (NICU) in Bristol have conducted a clinical review of neonatal services in the area following the publication of a national review with recommendations for regional neonatal services.

There are three levels of neonatal care, specialist care for very ill babies. All 3 levels of neonatal care are currently provided in neonatal units at Southmead (North Bristol NHS FT) and St Michael’s (University Hospital Bristol NHS FT) hospitals in Bristol. The neonatal unit at Southmead cares for around 770 babies each year and the neonatal unit at St Michael’s cares for around 750 babies each year.

Specialised commissioners and a project team from the two NICU units in Bristol have listened to a range of clinical experts, patient representatives and their families to develop and appraise options for how neonatal services in Bristol could be arranged differently to ensure all babies born in Bristol are delivered in the right place at the right time with the right level of staffing to achieve the best outcomes for children and their families. Details are shared in the report below.

South West Gender Identity Review Programme

Specialised Commissioning South West held a SPRINT workshop on 30 June, as part of the Gender Identity Review Programme. More than 75 Gender Identity Clinic clinicians and staff, primary care staff, Integrated Care System (ICS) staff,  stakeholders including from the Voluntary and Community and Social Enterprise sector and service user representatives attended.

An outcome of engagement report following the SPRINT workshop for the South West Gender Identity programme is here.

The report describes discussions and a summary of the insight gathered. The design of the workshop was informed by the insight from an independent survey commissioned from and run by the Intercom Trust, an LGBTQ+ support organisation in the South West.

The Development Team, Direct Commissioning are working with the Specialised Commissioning team and stakeholders to use this outcome of engagement report to shape the next steps for the programme. The engagement event results will be used to further develop a non-surgical GI pathway that makes the South West a better place for T+ people to live and for GI practitioners to work and inform the development of a business plan for a revised South West Gender Identity Service.

Gender Services Review

Our Specialised Commissioning Team are working with stakeholders to review the non-surgical gender identity service in the South West, looking at how to shape and improve the future service model for all Transgender people across the region.

In order to coproduce an integrated and person-centred care pathway, the team are

engaging with trans people and the community and statutory organisations that provide them support along the pathway. Work began with a survey that was codesigned with independent LGBTQ+ charity Intercom Trust and completed by 876 Trans people who all have lived experience of the current service.

Following publication of the survey report,  a workshop was held to bring together groups of people who all have expertise that could help to improve and co-design a better care pathway for those who are engaging with gender identity services. For example – Trans people receive support from a range of community as well as statutory organisations with each having an impact on the activity and demand experienced by the other. By bringing everyone together, including community counsellors, patient support charities, general practice and secondary care professionals, the workshop was an opportunity to discuss how they could work together to, for example, reduce waiting times.

A report following the workshop is available. The report will be used by the Specialised Commissioning team to develop a business plan to commission joined-up pathways for Trans people that dovetail in to both primary, community and secondary care.

Expansion of Retrieve

NHS England & Improvement South West’s Specialised Commissioning Team commissioned a regional dedicated Adult Critical Care Transfer Service – known as Retrieve – to support in-region and between-region transfers. In 2021, the service was expanded to carry out transfers nationally.

The service provides consultant-delivered advice and support for critical care transfers and offers consultant-led transfer teams. This means that Trusts under significant pressure can use the service to safely transfer patients to other hospitals while still ensuring that patients continue to receive the best possible care and support.

Before Retrieve, patients would have been transferred by clinical teams from the referring hospitals and, often, front-line 999 ambulances which consumed precious resource at busy times.


The critical care transfer service has played an important role throughout the pandemic, collecting patients from across the region and also within the South East, London and the Midlands and bringing them to our hospitals in the South West in order to support those across the country most under pressure and deliver the best patient care possible.

Find out more at: www.retrieve.nhs.uk