Commissioning can drive improvements in the quality of healthcare.

Stages of the commissioning cycle include assessing needs, setting priorities, contracting with providers and reviewing service delivery.

Evidence from previous forms of primary care–led commissioning (PCLC) suggests that clinical commissioning groups (CCGs) may prove more effective at developing primary and intermediate care than shifting funds from hospital services.

Successful commissioning requires managerial and financial expertise, accurate information and, crucially, the engagement of clinicians.

The commissioning cycle

The term ‘commissioning’ emerged from the creation of a National Health Service (NHS) ‘quasi-market’ as part of the Conservative reforms of 1990.

Within this quasi-market (‘quasi’ because operations of this market were closely managed by government), the roles of planning and procuring (purchasing) care were formally separated from that of provision – the so-called purchaser–provider split.

It is the role of commissioners to secure, rather than directly provide, services that meet the needs of the populations for whose health they are responsible. There are four main stages involved in commissioning healthcare, often referred to as the commissioning ‘cycle’, each of which provide opportunities for quality improvement.

In their comprehensive review of the published evidence, Smith et al. (2004) concluded starkly that ‘there is little substantive research evidence to demonstrate that any commissioning approach has made a significant or strategic impact on secondary care services’.

Increasing the effectiveness of commissioning

Certain factors may increase the effectiveness of commissioning but the evidence is limited.

  • Strong, skilled leadership.
  • Organisational stability.
  • A blend of incentives, financial and non-financial, to promote clinical engagement.
  • Access to high-quality, up-to-date information at practice level to evaluate and inform commissioning decisions.
  • Worthwhile in-service training opportunities for those leading CCGs.
  • Even distribution of the managerial resources required to underpin commissioning.
  • Tried and tested mechanisms of public accountability.