The aim of this paper, written for commissioners, managers, and health decision-makers, was to look at how commissioning works for people with long-term conditions such as dementia. The authors carried out a multisite mixed methods case study research, involving three ‘commissioning communities’ and using interviews, documents, and meeting observations to reach their conclusions. A commissioning community is “the area covered by a single primary care trust”. They found that there is little evidence of commissioners using decommissioning or tendering for new forms of service and other market-style techniques, when commissioning new services.
Commissioning and provider role
The organisations represented the North and South of England, and each focused on two long-term condition services. All of the sites looked after people with diabetes, with two of the sites also looked after people with dementia, and one looking after people with stroke. The study focuses “on five areas:
- The process of commissioning
- The type of activities undertaken
- The range of people involved
- The time and effort expended
- The potential service gains allied to commissioning”
Issues with commissioning for long-term conditions
The results showed the following with regards to commissioning for long-term conditions:
- It is not sequential and therefore does not follow the commissioning cycle.
- Ensuring commitment from all stakeholders is essential, as is aligning with strategic priorities.
- Providers, local authorities, patients, clinicians, and not just commissioners, are often very active throughout the commissioning process.
- It can be very labour-intensive and time-consuming because often commissioners work with people with whom they have no managerial authority.
- The scale and the intensity of the work did not always match the impact
This research demonstrates all the intricacies involved with commissioning services for people with long-term conditions. These people also need carer support and in previous Commissioning Elf posts, we have highlighted research that shows the importance of making sure services are commissioned for carers too, to ensure their continued well-being, as their support can help commissioners meet financial targets.
This article is full of useful information, including a table of definitions of the stakeholders included in the study, and the commissioning cycle, which demonstrates all the activities involved in commissioning. However, it demonstrates that while the commissioning cycle is a useful tool, it does not reflect the practice of commissioning for long-term conditions. Do you use a different tool to support commissioning? Is it more effective than the commissioning cycle? Think about how you commissioning services for people suffering from long-term conditions and the stakeholders that you involve. Are you working in partnership with the most relevant parties? Is there a way you could work together to alleviate some of the pressures on resources? This paper provides lots of information for discussion and reflection.
SE Shaw, JA Smith, A Porter, R Rosen, N Mays. The work of commissioning: a multisite case study of healthcare commissioning in England’s NHS (PDF). BMJ Open, 2013, 3:e003341.
Related Commissioning Elf posts
De Brún, C. “Carers can help commissioners meet financial targets”, according to report. The Commissioning Elf, 13 Aug 2013.