Commissioners’ priorities for improving the NHS

Chrysalis butterfly


Chest containing moneyThis document is relevant to commissioners, public health, local authorities, Clinical Commissioning Groups, and Health and Wellbeing Boards. Originally published in March 2011, it has been updated due to the changes taking place in the NHS as of 1st April 2013. The changes involve more than £65 billion of public money, representing the NHS budget, becoming the responsibility of 211 Clinical Commission Groups (CCGs), who will use it to commission secondary care and community services. A further change to the health finance system, will be the £2.7 billion public health budget, which will be transferred together with the budget for local services, such as education, housing, and social care, to local authorities.

Structure of the new NHS

This new system will be made up of:

  • 211 Clinical Commissioning Groups
  • 152 local authorities
  • 152 Health and Wellbeing Boards
  • 27 NHS England area teams
  • 19 commissioning support units.

These organisations will work together with the purpose of making the NHS sustainable in spite of all the financial challenges currently being faced and the increased burden of disease resulting from people living longer and an increase in long-term conditions.

Commissioning priorities

The King’s Fund has identified ten priorities for commissioners to help them drive the following four agendas:

  1. a more systematic and proactive approach to the management of long-term, chronic conditions;
  2. helping patients to be more involved in their treatment decisions;
  3. focusing on the wider population rather than individuals who visit the GP practice the most;
  4. integrated, seamless care.

List of priorities with quality checkedThe ten priorities are listed below, but are discussed in greater depth in the full report, describing why each is important, what the impact is, and how to implement each priority:

  1. Active support for self-management
  2. Primary prevention
  3. Secondary prevention
  4. Managing ambulatory care-sensitive conditions
  5. Improving the management of patients with both mental and physical health needs
  6. Care-co-ordination through integrated health and social care teams
  7. Improving primary care management of end-of-life care
  8. Medicines management
  9. Managing elective activity-referral quality
  10. Managing urgent and emergency activity

Towards the end of the document, there is a matrix mapping each priority’s impact on health outcomes, patient experience, savings, and ease of implementation. It concludes by briefly describing three areas that need developing, namely organisational development, transactional skills, and transformation skills, in order for this work to be successful.


This document is very important, because at present the new roles that are being taken on seem quite overwhelming, so it is useful to have some initial steps presented on where commissioners should start, written by leading experts in the area of health management. Not only does each priority tell you how to implement itself, but there are also links to relevant support materials.

Work through this list and see how your organisation can implement each priority. With this report, The King’s Fund is helping you to map your priorities against those listed, and hopefully you will find common ground and synergies to work work on for the future sustainability of the NHS.


Transforming our health care system: Ten priorities for commissioners (PDF)
C Naylor, C Imison, R Addicott, D Buck, N Goodwin, T Harrison, S Ross, L Sonola, Y Tian, N Cuurry
The King’s Fund
March 2013

Further reading

10 priorities for commissioners from April
C Imison
Health Service Journal, 27th March 2013

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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