What happens when GPs engage in commissioning? Two decades of experience in the English NHS

Abstract

Evidence for a significant impact of clinical engagement on commissioning outcomes is limited. Initial changes are likely to be small scale and to focus on services in primary care. Engagement of GP members of primary care commissioning organizations is an important determinant of progress, but generates significant transaction costs.

Clinically led commissioning: past, present and future?

“…Simon Stevens took over as Chief Executive of NHS England, and quickly published his 'Five Year Forward View' (FYFV) (NHS England, 2014a). This document set out the scale of the inancial challenge facing the NHS, and suggested that this challenge could only be met if the NHS did things diferently.…”

“…prucomm.ac.uk) and in academic papers (Checkland et al, 2013a;Checkland et al, 2013b;Coleman et al, 2014; 166 Petsoulas et al, 2014;Segar et al, 2014;Coleman and Glendinning, 2015;Miller et al, 2015). Part of the chapter was previously published as an article in the British Journal of General Practice (Checkland et al, 2013b), and we are grateful to them for permission to reproduce it here.…”

“…This means holding responsibility for GP practice contracts, and raises issues of conlicts of interest as GP-led organisations will be commissioning their own practices. Three 'levels' of involvement were ofered: full delegation of responsibility; joint commissioning, with CCGs and NHSE (NHS England) working together; and 'greater involvement', in which CCGs would advise NHSE on aspects of primary care commissioning (NHS England, 2014b). There is a clear expectation that those CCGs which opt for a lower level of involvement will, over time, move to take on further responsibility, but no irm timescale has been set for this.…”

“…This and the subsequent section draw on a comprehensive literature review carried out between 2011 and 2014 Miller et al, 2015), where all the relevant references can be found. Clinical involvement in the commissioning of healthcare services started with the introduction of the quasi-market into the NHS in 1991.…”

Redesign and commissioning of sexual health services in England – a qualitative study

“…These included a transfer of responsibilities for commissioning some public health services. Commissioning is the planning and purchasing of services to meet the needs of a population, which in England, operates in a quasimarket 1 . As part of the reforms, the commissioning of sexual and reproductive health (SRH) services are no longer solely the prerogative of the National Health Service (NHS).…”