Understanding the new commissioning system in England: contexts, mechanisms and outcomes

Healthcare commissioning is the process by which population needs are assessed, and appropriate health care is purchased to meet those needs from organisations providing care. Introduced in the NHS in 1990, this separation between the roles of planning and purchasing care on the one hand and providing care on the other, is claimed to support an effective and efficient health system. In 2012 there was a significant reorganisation of the NHS in England (enacted in the Health and Social care Act 2012 (HSCA12)), with the abolition of some organisations, the creation of others and a significant redistribution of responsibilities for commissioning different types of healthcare. The changes were comprehensive, affecting most types of organisation in the NHS. Not only was there a wider variety of types of organisation in the new system, but also responsibilities for commissioning some types of services were divided between a number of different organisations. These changes (and other aspects of the reorganisation) were intended to: give front line NHS clinicians more freedom and a greater role in commissioning; increase the efficiency of the NHS by promoting greater competition between providers; focus commissioning activity upon achieving particular outcomes rather than on counting activity; create a new Arm’s Length Body (NHS England) to oversee the running of the NHS; and to transfer responsibility for public health to elected Local Authorities. In order to investigate the impact of the changes in respect of commissioning, we undertook a three year study using qualitative and quantitative methods to explore how the new commissioning system was functioning. This research aimed to assess the impact of the reforms on the operation and outcomes of the commissioning system.

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