The authors of this paper found that the way people search for evidence relating to commissioning decisions varies, depending on their professional background. That is why this paper is particularly pertinent to commissioners, policy decision-makers, health managers, and medical librarians, who have the necessary skills to help staff working in commissioning to find the best evidence.
Three hundred and forty-five staff involved in making commissioning-related decisions and graded at NHS band 7 or above participated in this research to find out how important different sources of evidence are in commissioning decision-making. Employees involved in commissioning come from a variety of backgrounds, not just clinical, but non-clinical, such as business studies and accounting, and therefore have other experiences and information sources to bring to the NHS.
The evidence sources that people making commissioning decisions used, included NICE Guidance, best practice examples, local polices and plans, personal experience, government publications, secondary sources, such as NHS Evidence, etc. There is a useful table which illustrates the findings very clearly.
Surprisingly, academic researchers and management consultants were seen as of limited importance or were not used. The most important evidence source was local public health intelligence.
The authors found that 50% of healthcare decisions made by commissioners were not based on clinical evidence, and 50% did not take into consideration the cost effectiveness of different treatments. This lack of evidence use goes against the evidence based practice concept which demonstrates which is the most clinically and cost-effective treatment available, to ensure that high-quality care is delivered.
The survey results also showed that “participants at NHS pay grade 8b or above were more likely to report higher importance of practical evidence in their commissioning decisions”, while people with a public health background were more likely to use empirical evidence. This is an important observation because it could lead to variations in the decisions made, and therefore new CCGs should reflect a healthy balance between those decision-makers basing their decisions on evidence and those on experience. It is important that there is consistency in the use of evidence and experience throughout the commissioning decision-making process.
Finding the evidence to support commissioning decisions is different to finding the evidence to support clinical decisions. Information sources are more widely dispersed, and can come from other sectors. This is a useful paper because it is sharing knowledge of information sources that have been already tried and tested by commissioners. Medical libraries can also support this information need as they have the time and skills required to find the best clinical and non-clinical evidence.
As staff working in health and social care commissioning, what you need to think about now is, whether you are aware of and are using the resources described in this paper? Are you basing your decisions on the best evidence or are you relying on your experience? Evidence-based practice is a combination of experience and evidence, so both have a place. By applying the evidence, your decisions will be more robust and people will be more likely to apply them if they are built on strong foundations.
The paper concludes by saying that “New Clinical Commissioning Groups will need a variety of different professional experts and sources of evidence to ensure that effective commissioning decisions are made for their populations.” This is an opportunity for librarians to work with Commissioning Support Units to support the evidence-needs of commissioners and all decision-makers.
Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011 (PDF)
A Clarke, S Taylor-Phillips, J Swan, E Gkeredakis, P Mills, J Powell, D Nicolini, C Roginski, H Scarbrough, A Grove
BMJ Open, 2013, 3:e002714