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Commissioning levels

There is not a single ‘ideal’ location for commissioning services. The task for commissioners is to decide the most appropriate level to achieve the required outcomes and the specific local commissioning configuration i.e. where to allocate the responsibility for carrying out particular commissioning activities in the area served.

The need to focus on a multi-layered approach to commissioning has come to the fore in the past year as the government has sought to focus health and social care more on to communities and individuals. The government’s plans envisage a much enhanced role for local authorities in leading within their local areas and working with a range of organisations at varying levels.

Levels of responsibility

More information on the government’s vision for social care can be found here. There is also further information on the government’s plans for public health, which maps onto the proposals for health and social care. ‘Healthy Lives, Healthy people: our strategy for public health in England’ sets out the government’s plans for public health to be devolved more to local areas and coordinated by local authorities working with communities, health providers including GP consortia, businesses and other organisations. This sets out a model which can be applied to commissioning.

Individuals should be given as much control as possible over their own and their family’s health, wellbeing and care, maintaining good health, managing any long-term conditions and sharing decision-making with health and social care professionals using good information, dialogue and personal budgets. Services and support should be delivered in partnership between individuals, communities, local authorities, NHS organisations and the voluntary sector.

Communities. The government proposes that communities should be given information about commissioning decisions and how public health money is spent locally. Communities will be empowered to bid to take over local state-run services and the government’s proposed ‘Big Society Bank’ will seek to bring in investment for charities and social enterprises to encourage local innovation and enterprise. The role of strategic commissioning will need to change to reflect the increasing importance of individual and locality commissioning as well as the shift to GP commissioning. Local authorities will be expected to take on many of the responsibilities of PCTs, including the role of developing markets for the whole community by leading and coordinating the activities of different agencies, including GP consortia.

GP consortia will have responsibility for communities as NHS commissioners and they will be encouraged to work with local authorities and other organisations to deliver services and address public health.

Local authorities will take on a leading role under government proposals to influence public health and wellbeing, including encouraging joint commissioning with NHS organisations, social care providers and other partners. The government intends to enhance the role of local government, including providing dedicated, ring-fenced funding to reward local progress and initiatives. The aim is to empower local communities and to offer professionals greater freedom to innovate, using evidence of what works best. Local leadership will be enabled and wider responsibility will be encouraged to improve health and wellbeing and to address the factors which contribute to it.

Local organisations. The government has highlighted the continuing importance of NHS providers, particularly in prevention and in supporting people with long-term conditions. It has acknowledged the importance of charities, voluntary organisations and community groups and it aims to encourage partnership working, with opportunities for groups to provide relevant services under the new proposals. The role of businesses is also highlighted in terms of their impact on communities and in contributing to the welfare of their staff. The government proposes a new ‘Public Health Responsibility Deal’ to encourage collaboration between business, voluntary groups and other organisations.

Local health and wellbeing boards will be established to bring together elected representatives, GP consortia, Directors of Public Health, Directors of Adult Social Service, Directors of Children’s Services and other partners where appropriate. GP consortia and Directors of Public Health will in future have an explicit obligation to jointly prepare the local JSNA through arrangements made by the health and wellbeing boards. Joint health and wellbeing strategies will emerge from the JSNA, setting out how commissioners can work together to achieve the aims set out.

National level commissioning.

  • A dedicated national public health service set up with DH, Public Health England, will support local innovation as well as providing disease control and protection, together with information on public health innovations from elsewhere. Public Health England will have a protected budget and it will support local action through funding, professional support and evidence, as well as ensuring that the country remains resilient to health threats.
  • The Chief Medical Officer (CMO) will be tasked with providing advice on the population’s health to the Secretary of State and the government. The CMO will act as the leading advocate for public health and they will lead a professional network for those responsible for commissioning or providing public health.
  • The NHS Commissioning Board. Under plans for GP commissioning, a new NHS Commissioning Board will be established to support GP consortia, setting commissioning guidelines and standards and commissioning services which cannot be commissioned solely by consortia. As mentioned above, local authorities will be expected to promote and encourage integration and partnership working between the NHS, social care, public health and other local services.

Procurement

Procurement is not the same as commissioning, although the words are sometimes used interchangeably.

Procurement, purchasing and contracting are activities that focus on a specific part of the wider commissioning process – the selection, negotiation and agreement with the provider of what service is to be supplied. Procurement or purchasing usually refers to the process of finding and deciding on a provider. Contracting usually refers to the negotiation and letting of a contract and its subsequent monitoring.

Click here for a glossary of commissioning related terms and their meaning.

Office of Government Commerce procurement process

Procurement follows a cycle starting with the identification of need to purchase a service and finishing with the end of a contract. It therefore has parallels with the cyclical process of commissioning.

The model describes the cycle of procurement from the identification of need to the end of a project. It sets out the stages required for a robust procurement process, including making a business case, selecting a supplier or suppliers, management of the contract and the eventual closure of the contract. The model differs notably from commissioning models in not explicitly identifying a review point, although this is included under ‘project closure’.