Highs and lows of commissioning over the past ten years

Trees reflected in a canal


The report provides practical guidance and support for NHS employees working in the new NHS system, in particular commissioners working in clinical commissioning groups, local authorities, and NHS England (NHS Commissioning Board).

The NHS Confederation is an organisation that identifies best practice and helps NHS staff to implement it. It has produced this report to bring together lessons learned over the past 10 years with regards to commissioning in the NHS and the recent transition into the new system. The content is based on interviews carried out with 20 leading figures in commissioning, and provides important information for people working in the new commissioning bodies.

At the start of the report there is a useful timeline, highlighting the evolution of NHS commissioning, from the internal market to PCT mergers, world class commissioning, and finally 2013 and the launch of the new commissioning arrangements. This is followed by several chapters looking at the following topics:

  1. Building capacity and capability
  2. Meeting local needs and reducing inequalities
  3. Working with providers
  4. Improving primary, secondary, and tertiary care
  5. Supporting clinical leadership
  6. Partnering with local government
  7. Communicating with the public

Each chapter draws on the experience of people who have steered commissioning programmes in the NHS, including Chief Executives, Chief Operating Officers, Chairs, and Directors of NHS organisations, such as the Commissioning Support Units, Primary Care Trusts, and Strategic Health Authorities. Together, these leaders have described the challenges they have overcome to support the successful transition of the NHS into the new system. NHS Confederation provides describes the differences between previous initiatives and the current state, making it clear what clinical commissioning groups (CCGs) can expect with regards to issues that they will face, such as financial pressures. Advice is given, for example, the former NHS Tower Hamlets Chief Executive and the former Chief Operating Officer of NHS Birmingham East and North, both stress the importance of organisational development in achieving success, the latter saying ‘The first thing we do in this CCG is not think ‘how do we do it’, but ‘who can we do it with’ or ‘who can do it for us’. This further emphasises the importance of collaborative working towards shared goals, between the NHS and local authorities.

At the end of each chapter, there is summary of the key points for new commissioners.


This report is very important because it means that Clinical Commissioning Groups do not have to start from scratch. They can see what has worked and has not worked, and build on advice given to them by people who have had hands-on experience of commissioning and building partnerships with organisations internal and external to the NHS. It provides lessons that Clinical Commissioning Groups can learn from and build on to improve the service delivered to patients. It is a well-collated source of expert opinion, produced in a readable format, and the end-of-chapter summaries are particularly useful as they summarise what CCGs need to do and what problems they might have to overcome.

Everyone involved in commissioning in the NHS should read this report and reflect on the advice given. Is it applicable to your organisation? Do the practices sound familiar? Can you see where your organisation could improve? By learning from previous experiences, hopefully the new system will be more robust, improving service delivery and the patient experience.


Ambition, challenge, transition: reflections on a decade of commissioning (PDF)
NHS Confederation
April 2013

Further information

NHS Confederation
NHS England

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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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