Systems levers for commissioning primary mental healthcare: a rapid review

Abstract

Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. A rapid review of academic and grey literature published between 2006 and 2016 was undertaken to describe the use of systems levers in commissioning primary care services. Fifty-six documents met the inclusion criteria, including twelve specific to primary mental healthcare. Twenty-six levers were identified. Referral management, contracts and tendering processes, and health information systems were identified as useful levers for implementing stepped care approaches. Location, enrolment, capitation and health information systems were identified as useful in implementing a healthcare homes approach. Other levers were relevant to overall health system functioning. Further work is needed to develop a robust evidence-base for systems levers. PHNs can facilitate this by documenting and evaluating the levers that they deploy, and making their findings available to researchers and other commissioning bodies.

Implementation opportunities and challenges identified by key stakeholders in scaling up HIV Treatment as Prevention in British Columbia, Canada: a qualitative study

“…To our knowledge, this is the first study to identify how these kinds of soft levers may have profound influence in the implementation of systems-level changes in HIV treatment and prevention. While literature on systems levers for primary mental health care has identified how soft levers such as engagement (i.e., activities to foster and maintain relationships and dialogue among stakeholders) can influence health system change, soft levers identified in our study and the mechanisms through which they influence systems-level changes have yet to be documented in health literature [31], thereby indicating that future research in this area is warranted.…”

Project Synergy: co‐designing technology‐enabled solutions for Australian mental health services reform

“…At present, there are major gaps in the data available (highlighted in an independent evaluation by headspace, Australia's Youth Mental Health Foundation); 13 of the 24 identified National Mental Health Performance Framework data indicators remain undefined and require further development . More recently, Primary Health Networks have been charged with commissioning regionally appropriate, community‐based mental health services and have reported substantial challenges in accessing clinical data to assist them to fulfil their responsibilities.…”

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

“…Enablers to co‐commissioning include having clearly defined objectives, strong relationships, commitment from leadership and staff, dynamic governance, and a commitment to complete the initiative (PwC and Commissioning NSW, 2020, p. 12). While commissioning itself is a relational process and relies on engagement with key stakeholders (Bates et al., 2022; Meurk et al., 2018; Robinson et al., 2016), co‐commissioning relies on deep collaboration which requires both time and resources to achieve (Cheverton & Janamian, 2016). The CasePHN, being a relatively new organisation, in terms of region and governance, has taken time to establish new relationships with key stakeholders in its region.…”

“…This study draws from data collected from a single case study organisation and its early experiences of co‐commissioning. While the findings relating to the transaction costs of commissioning with other parties are likely to resonate with other commissioning agencies, the findings reflect the maturity of the PHN and the maturity of its relationships with commissioning partners—as well as their broader understanding and experience of implementing commissioning processes (Meurk et al., 2018). While co‐commissioning has progressed since the data were collected, with further examples of co‐commissioning and collaborative commissioning by PHNs and other funders (Koff et al., 2021), the insights provided in this paper provide useful insights to inform and strengthen co‐commissioning practice by providing an understanding of the organisational and operational considerations when co‐commissioning services—not just for PHNs, but also for other commissioning agencies.…”