Commissioning strategies / prospectus

In 2006, the Department of Health's Health reform in England: update and commissioning framework outlined the requirement for PCTs to publish a Prospectus to set out the strategic direction for local services, highlight commissioning priorities, needs and opportunities to service providers, offer a focus for discussion with patients and the local community and an opportunity to open dialogues with potential providers.

The strategic direction of local services will now be decided by local authorities and GP consortia together, with the responsibility for local health improvement, social care and strategic commissioning of local NHS services passed to local authorities. Local authorities will lead on the preparation of Joint Strategic Needs Assessments, sharing responsibility for this statement with local GP consortia.

If the JSNA provides the key data about the local population and its needs, the task of commissioners is to plan how best to meet those needs in the context of available resources and the relevant national and local policy drivers. The key document outlining the agreed strategic plan is sometimes called a prospectus but is more generally known as a commissioning strategy.

Commissioning strategies

A commissioning strategy is concerned with effecting change in the overall configuration of services across a market to meet the needs of a whole population. It is a plan specifically developed by commissioning agencies and is a statement of commitment about the way in which they intend to work with providers and purchase services for the population.

Commissioning strategies vary considerably in their purpose and in their relation to other documents, and hence in what they include. This can be viewed as a spectrum:

Commissioning strategy spectrum

Source: Institute of Public Care

Commissioners will need to decide the boundaries for a strategy and what elements it will contain. It will be necessary to decide at the outset what sort of strategy is required, e.g. what elements will be joint and what separate, how comprehensive should it be, what basic ingredients should it include and the limits of the strategy. This framework will guide those producing the strategy. A planning template can be downloaded here to help with the design.

A comprehensive commissioning strategy will usually comprise a combination of the following:

  • A statement about the purpose and the commitments of the commissioning agencies in relation to meeting the needs of the relevant population;
  • An analysis of relevant legislation, national guidance, research and good practice on services to meet the needs of the relevant population;
  • An analysis of the needs of the relevant population and how these are likely to change in future;
  • An analysis of current and potential services and resources and the extent to which they are likely to meet future needs;
  • A gap analysis showing the strengths and limitations of current services, the changes needed, and some detail about the types of services which will be commissioned, and the types which will not be commissioned in future;
  • Plans to monitor and review the impact of the strategy upon the range and quality of services delivered, and upon the outcomes for the population.

The development of a commissioning strategy is a significant project in its own right, given the importance of involving all stakeholders and the need for as much consultation as possible. There needs to be clear leadership and well planned processes. The strategy document should be limited to this: other documents will be connected and cross-referenced to the strategy but the core document should not overdo the detail. Some relevant related documents will include a communications plan, a detailed needs assessment, an operational plan and a diversity impact statement. There may also be links to other related strategies.

Attention also needs to be given to how the strategy will be finally agreed and launched, with a clear communications plan which includes the different partners and the relevant politicians. The whole process will need to be carefully coordinated and sufficient time allowed. In terms of communicating the strategy effectively different versions should be produced with a jargon free summary available for general use.

The project planning template outlines a six stage approach, the first of which is project preparation or set-up, which usually includes agreeing clearly specified stakeholder roles. It might also be helpful to draw an outline joint planning structure and confirm individual roles.