Healthcare commissioning for people with long-term conditions: new report from the Nuffield Trust

Man looking at piles of coins

What do healthcare commissioners actually do? Ask a hundred people who work in the NHS and you’ll probably get a hundred different answers. The landscape is moving quickly as we approach the April changeover, and with management budgets getting cut, it’s an increasingly challenging area to work in.

This new report from the Nuffield Trust looks at what commissioners do to have an impact on healthcare delivery at a local level. It’s the report of a two year study, which focuses on three high-performing primary care trust (PCT) areas (Calderdale, Somerset and the Wirral).

The study used an ‘action research’ approach to investigate the practical day-to-day experience of doctors, managers, user and carer representatives and others within primary care trusts who are responsible for working together to commission long-term condition services.

The authors measured the impact that commissioning had on people with long term conditions and also looked forward to assess what is likely to happen when the new commissioning structures come into place from April.

Key findings of the study include:

  • The role of money in commissioning practice was observed to be intermittent and at times peripheral
  • Tackling ‘bite-sized’ commissioning tasks as part of a wider local plan for service delivery was seen as being more likely to lead to success
  • The loss of experienced staff in recent months is likely to have a significant impact in the near future
  • National guidance provided top-down impetus to get things done, presented templates for services, and provided a framework for local decision-making and the identification of priorities

Lead investigator and Nuffield Trust Director of Policy, Dr Judith Smith said:

This research revealed the ‘labour’ of commissioning to be extensive and resource-hungry, especially when designing and specifying services. What was less evident was a robust approach to assessing the performance, quality and impact of local services, and willingness to provide necessary challenge to existing local providers.


Smith J. et al Commissioning high-quality care for people with long-term conditions. Nuffield Trust, 1 Mar 2013.

Executive summary (20 pages, PDF)

Full report (233 pages, PDF)

Dr Alison Porter, report co-author discusses the main findings of the Nuffield Trust research into what commissioners do on a day-to-day basis.

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