Commissioning is the process by which health and care services are planned, purchased and monitored. Here we look at the commissioning process in more detail, the organisations involved and how it is changing. When they were first established in , there were CCGs, but over time the number has changed and is continuing to change, as described in the section on joint commissioning below.
CCGs have a statutory responsibility for commissioning most NHS services including urgent and emergency care, acute care, mental health services and community services. Increasingly they are also involved in commissioning primary care and some specialised services see section on collaborative commissioning below. CCGs are groups of local GP practices whose governing bodies include GPs, other clinicians such as nurses and secondary care consultants, patient representatives, general managers and — in some cases — practice managers and local authority representatives.
This includes specialised services, such as neonatal services and treatments for rare cancers, and primary care, including GPs, pharmacists, dentists and opticians — although increasingly these responsibilities are being shared with CCGs see below. NHS England also commissions some public health services, such as immunisation and screening programmes, as well as health care for people in prisons and secure units and some services for the armed forces.
As well as commissioning services directly, NHS England is responsible for assuring the quality of CCG commissioning through an annual assessment process. Local authorities are responsible for commissioning publicly funded social care services. This includes services provided to people in their own homes as well as residential care services. Since , local authorities have also been responsible for commissioning many public health services including sexual health services, health visitors, school nursing and addiction services as mentioned above, some public health services are commissioned by NHS England.
Government is yet to decide whether the grant will continue to be ring-fenced in future years. In addition, health and wellbeing boards , formal committees of local authorities that bring together local authority and NHS representatives , are responsible for carrying out a joint needs assessment with CCGs and developing a joint health and wellbeing strategy for their local population.
Support for commissioning activities is available from commissioning support units CSUs and a range of private and voluntary sector organisations. These organisations support commissioners in a range of ways. For example: helping them plan and manage services by providing access to real-time information about the local health system; enabling them to deliver better population health outcomes and integrated care through analytical and transformation support; and supporting their operational functions by providing transactional services like finance and payroll.
They provide services for a range of organisations that include local authorities and hospitals as well as CCGs and NHS England, and they are increasing their support to whole systems rather than just individual organisations.
The current system is based on arrangements set out in the Health and Social Care Act , which aimed to put GPs at the forefront of the commissioning process. Although the structures established by the Act have remained in place since it came into force in , the way that commissioning is delivered in practice has evolved since then — and is continuing to do so. NHS England and NHS Improvement have proposed legislative changes to support these new ways of working, but there is currently no timetable for putting the proposals before parliament.
Key changes to commissioning include the delegation of some responsibilities from national to local organisations and systems, and greater joint working between different commissioning organisations and between commissioners and providers. Some of the key changes that have taken place, which are likely to characterise the development of commissioning over the next few years , are set out in the sections below.
This was intended to support a shift in investment from acute to primary and community services. NHS England recently set out plans to give local systems rather than just commissioners a greater say in how the specialised commissioning budget is spent in their area.
Local areas can apply to take on greater responsibilities, although there is no single model for this and proposals are approved on a case-by-case basis. Greater Manchester is an example of an area that has taken on greater responsibilities for commissioning a range of specialised services. CCGs are increasingly working together to commission services across their local populations and deliver economies of scale. In many areas two or more CCGs are sharing staff or have shared management structures; most now share accountable officers.
Some CCGs have established new governance arrangements to support joint commissioning, such as joint committees. These arrangements are often accompanied by the pooling of commissioning budgets. Some CCGs have gone further by formally merging with their neighbours into a single organisation. Since CCGs were created in there have been 10 formal mergers , reducing their number to as at April More mergers have been proposed for , which — if approved — could further reduce CCGs numbers by a third.
Many CCGs and local authorities are also working together to support more integrated health and social care. Arrangements vary, ranging from joint working to the establishment of new governance and financial arrangements, including integrated commissioning boards and pooled budgets. Some local authorities have transferred commissioning responsibilities to CCGs and vice versa, and some areas have made joint appointments across the two organisations — for example, in Tameside and Glossop, the CCG accountable officer is also the chief executive of the local authority.
The Better Care Fund , a national programme designed to support integrated care, encourages CCGs and local authorities to work together, by pooling health and social care budgets. Commissioning is the process of planning and purchasing health and care services to ensure they meet the needs of the population.
Carried out by local clinical commissioning groups CCGs and the national specialised services commissioner NHS England, it is a complex process which through careful planning and monitoring of services aims to improve outcomes and ensure high quality care. For commissioning to be effective, NHS Providers believes there needs to be a move away from short-term transactional and efficiency-driven approaches towards more strategic service design focused on understanding the health needs of the population and working in collaboration with local providers.
There is on-going debate about the best strategy to pursue in commissioning specialised provision. P roviders are facing challenging efficiency requirements for specialised services. NHS England has now established arrangements to co-commission some services, including primary care, in partnership with CCGs and has undertaken a number of individual reviews of specific specialised services.
This has helped to ensure appropriate engagement with all relevant parts of the service: commissioners, providers, patients and the public, and has facilitated discussion of issues such as the development of co-commissioning and the consequences of changes to the national tariff.
To find out more or provide views and feedback on any of the issues relating to specialised commissioning, please contact Edward Cornick or Miriam Deakin. CCGs were established on 1 April and are clinically-led statutory bodies that commission local healthcare services. We intend to work with our providers to develop sustainable services that provide consistent levels of care across the whole area, while also addressing the needs of individual communities.
Locally and nationally, the NHS system is facing major challenges to meet demand for services within resources available. It is only by working together that we can address these issues.
This is why NHS Planning Guidance outlined the expectation that every health and care system commissioners and providers will come together to create an ambitious plan for accelerating the delivery of the national NHS FiveYear Forward View — this is called an Integrated Care System formerly known as the Sustainability and Transformation Partnership..
Healthier Together involves all health and social care organisations across the area working collaboratively to ensure we meet the needs of the population. Each year commissioning intentions are subject to patient, public and stakeholder feedback and subsequent prioritisation.
We publish opportunities for you to contribute your views in the Get Involved section of our website. We also produce an annual report where you can find information such as member practice reports, performance reports, accountability reports and annual accounts.
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