Category Archives: Seminar

PRUComm Annual Research Seminar

Since the establishment of PRUComm in 2011 our research has focused on examining how the changes to the English NHS and public health system have developed. We continue to examine the development of CCGs and the new commissioning structures. We have also been exploring the mechanisms by which commissioning is undertaken, such as contracting and the use of competition and cooperation within the new system.

While most media attention has focused on changes to the commissioning and delivery of healthcare, the shift of public health to local authorities was a major part of the reforms introduced in April 2013. We have examined the progress and developments in the public health system with a particular emphasis on how governance and organisational structures develop and whether being embedded within local councils changes the way that public health services are provided. We have also been focusing on primary and community health care with recent projects examining general practice – including methods of funding primary care; research on recruitment and retention; QOF, scaling up primary care and running and analysing two rounds of the GP WorkLife survey (eight and nine).

Our research on CCGs has most recently focused on primary care co-commissioning and new forms of contracting, such as outcomes-based and alliancing. Given the increasing policy emphasis on this area of healthcare we anticipate that we will be increasingly involved in further research on primary and community healthcare. All these topics will be explored in today’s seminar with presentations by researchers from PRUComm.

Programme and speakers biographies [pdf]>>


9.30 Registration and refreshments

10.00 – Welcome and introduction: Professor Stephen Peckham (Director PRUComm).

10.00 – 10.25 Jonathan Walden: (Commissioning Policy Lead): Policy update – Department of Health and Social Care priorities.  Slides [pdf]>>

10.25– 11.00 Dr Lindsay Forbes: Incentivising GPs: Review of the Quality and Outcomes Framework in England. Slides [pdf]>>

11.00 – 11.20 Coffee

11.20 – 12.00 Dr Jon Gibson and Prof Kath Checkland: Satisfaction, sources of stress and intentions to quit amongst GPs in England: the results of the 9th GP Worklife survey

12.00 – 12.40 Dr Marie Sanderson: Examining the implementation of new models of contracting in the NHS: what are the lessons for the formation of Accountable Care Systems?

12.40 – 13.20 Lunch

13.20 – 14.00 Dr Valerie Moran: How are CCGs managing conflicts of interest when they commission primary care? Lessons for Accountable Care. Slides [pdf]>>

14.00 – 15.50 Panel Discussion – STPs, and ACS’s the re-emergence of planning?

15.50 – 16.00 Professor Stephen Peckham: Current PRUComm research programme

16.00 Close

Supporting effective commissioning in healthcare: Clinical Commissioning Groups, specialised services, and next steps for CSUs

Central London
Tuesday, 9th September 2014
This event is CPD certified


Guests of Honour: Professor Peter Kay, National Clinical Director, Musculoskeletal Services, NHS England and Bob Ricketts, Director of Commissioning Support Services and Market Development, NHS England

This seminar focuses on supporting effective commissioning in healthcare.

Delegates will consider what more can be done to support primary care and specialised commissioning – with plans being made to give Clinical Commissioning Groups powers to co-commission primary care services and a five year strategy for specialised services currently in development.

Discussion will be informed by the publication of NHS England’s guidance for moving Commissioning Support Units (CSUs) towards operational autonomy by 2016 – expected to be published in July 2014.

Further sessions focus on the role of third and private sector organisations in delivering commissioning support services, challenges facing CSUs relating to funding, staffing and competition, and wider issues in healthcare procurement.

Bob Ricketts, Director of Commissioning Support Services and Market Development, NHS England and Tim Decamp, Head of Mutuals Programme, Cabinet Office will deliver keynote addresses at this seminar.

We are delighted that Professor Peter Kay, National Clinical Director, Musculoskeletal Services, NHS England; Bob Ricketts, Director of Commissioning Support Services and Market Development, NHS England and Tim Decamp, Head of Mutuals Programme, Cabinet Office have kindly agreed to deliver keynote addresses at this seminar.

Dr Pauline Allen, Deputy Director, Policy Research Unit in Commissioning and Healthcare System (PRUComm) and Reader, Health Services Organisation, London School of Hygiene and Tropical Medicine; Beth Capper, Commissioning Support Programme Lead, Macmillan Cancer Support;Christopher Exeter, Director of Corporate Strategy, UnitedHealth Group; Dr Leigh Griffin, Managing Director, NHS Greater Manchester Commissioning Support Unit; John Howard, Director, Management Consulting, KPMG; Dr Etheldreda Kong, Chair, Brent Clinical Commissioning Group;Kenny Lee, Head of Tax Services, Liaison Financial Services; David Smith, Director, Health and Adult Services, Kingston Council and Chief Officer, Kingston Clinical Commissioning Group have also kindly agreed to speak.

Baroness Cumberlege, former Parliamentary Under-Secretary of State, Department of Health and Chair, All-Party Parliamentary Health Group has kindly agreed to chair a session at this seminar.

For further information & to book your place click here

Clinical Commissioning Groups: one year on

By Neil Perkins

This was a well attended seminar hosted by PRUComm, The Nuffield Trust and the King’s Fund, on 1st May at The King’s Fund, London. Those attending included academics, policy makers and practitioners.

In April 2013 clinical commissioning groups (CCGs) took over responsibility for £65 billion of the NHS budget. One year on, the seminar reflected on progress made by CCGs during their first year in operation, and discussed key issues for their future development.

Three presentations were given at the seminar:

• Exploring the ‘added value’ clinicians bring to commissioning: views from the ground

This presentation was given by Dr Katherine Checkland (PRUComm). In the presentation, evidence was presented from an on-going study of CCGs as to what knowledge; skills and abilities clinicians (especially GPs), bring to CCGs. The research found that GPs believed they have a knowledge from working on the’ front-line’ and see their patients on a regular basis and thus know the problems and difficulties they encounter. They are able to feed back such experiences to managers, and the wider bodies of the CCG. Furthermore, GPs clinical knowledge is needed to inform service provision, pathway development and contextualise policy etc. It was being claimed that GPs bring a concrete knowledge of how the NHS actually performs in practice to the commissioning process, based in the real experiences of patients. Furthermore, that knowledge is fine-grained, distinguishing in detail between the experiences of different categories of patients and between services. Dr Checkland argued that although such knowledge is valuable, it may be not be used in a systematic and joined up manner and there is a danger that the focus on the value of this type of knowledge may crowd out more systematic population health knowledge and data.

CCGs: engaging members and supporting primary care development

Holly Holder (Fellow in Health Policy, Nuffield Trust) and Ruth Robertson (Fellow, Health Policy, The King’s Fund). In this presentation Holly Holder and Ruth Robertson reported on the latest findings from their study of CCGs they found that:
• One year on, CCGs have managed to broadly maintain overall levels of engagement, although fewer GPs remain highly engaged.
• CCGs were the organisation reported as having the greatest influence over GPs’ work; fewer said health and wellbeing boards were influential at this stage.
• GPs increasingly accepted that their CCG has a role in primary care development, and many saw the CCG as more effective at this than the previous PCT.
• There were signs that CCGs are influencing general practice. Some GPs reported their CCG has improved relationships between GPs, promoted multidisciplinary team working, and changed referral and prescribing behaviours. Fewer reported a positive impact on the overall quality of care they provide.

• Commissioning health care: comparing theories, policies and practice

Professor Rod Sheaff is a Professor in Health Services Research, Plymouth School of Government, Plymouth University. In this presentation Professor Sheaff presented the results of a recent NIHR-funded study which compared commissioning across three European countries. The team spent some time investigating the ‘programme theories’ underlying the English NHS reforms, and then compared these with the reality on the ground. The study report will soon be published on the NIHR website.

After the presentations a discussion followed, chaired by incoming Chief Executive of the Nuffield Trust, Nigel Edwards. The discussion questions included:
• Over the next year, what should CCGs focus on in terms of member engagement and primary care development?
• On which CCG activities should GP board members and other GPs with a formal role in their CCG focus their efforts?
• What policy changes would make CCGs role easier?

The diverse audience included CCG staff, academics, policy makers, staff from NHS England and representatives from the voluntary sector. The discussion was lively, and there was a general agreement that CCGs most of all need a period of policy stability to allow them to focus on the financial challenges facing the NHS. There was also a clear consensus that CCGs have an important role in supporting primary care development.

Summary of the seminar on healthcare commissioning

On February 19th the Policy Research Unit in Commissioning and the Healthcare System organised a seminar on health services commissioning. The aim of the seminar was to discuss current commissioning policy in England including:

  • Current policy developments
  • Early findings from the national research programme on Clinical Commissioning Groups
  • A view from the front line
  • Performance and governance issues

The day was attended by 50 researchers, Department of Health representatives and practitioners. During the day there were presentations that covered a range of policy and issues and evidence related to different aspects of healthcare commissioning. Download photos [pdf] >>

Professor Stephen Peckham (Director of PRUComm) started by introducing PRUComm’s research team and its current activity. Download slides [pdf] >>

The first presentation was by Ian Ellis (Team Leader for the Mandate group within the NHS Commissioning Policy and Sponsorship Unit on the NHS Policy & Outcomes Group at the Department of Health) and Pia Clinton-Tarestad (Head of Commissioning Policy and Resources, Commissioning Development, NHS Commissioning Board). They provided an overview of current policy developments and how the different responsibilities of the Department of Health and the NHS Commissioning Board are developing. Download slides [pdf] >>

There then followed two presentations on the development of Clinical Commissioning Groups. First,  Dr Kath Checkland (Associate Director of PRUComm) presented the results of PRUComm research on Pathfinder CCGs, highlighting some of the emerging issues that seem to be arising so far. It is based upon the findings of a web-based survey of Pathfinder CCGs, and on the early emerging story from 8 qualitative case studies, the presentation will provide a descriptive overview of the developing situation, in particular illustrating the organisational complexity that seems to be present on the ground. Some of the issues that have arisen along the journey so far will be discussed, alongside those things which have been experienced as problematic and those which have been found to be helpful by those involved. Download slides [pdf] >>

Next Chris Naylor (King’s Fund) and Natasha Curry (Nuffield Trust) presented some initial findings from a project that is tracking six CCGs over three  years, involving semi-structured interviews, observations and surveys. The first phase is exploring the internal dynamics of CCGs and the relationships that are developing between the CCG leadership and GP members. A particular line of enquiry is the role of the CCG in supporting and monitoring improvement in general practice and how that role might develop alongside the NHS Commissioning Board’s Area Teams. The presentation described, and presented early findings from, the first year of this project. Data collection is ongoing so the findings reflected on key themes that have emerged in interviews and observations already  completed. A publication documenting the findings from the first year of the project is planned for Summer 2013. Download slides [pdf] >>

In the afternoon we had three presentations that examined different aspects of commissioning. Professor Rod Sheaff (University of Plymouth) presented findings from an ongoing study that is examining governance mechanisms utilised by commissioners. Different commissioners apply different combinations of six methods of control (‘media of power’) for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. He presented findings providing a comparison of English and German healthcare commissioners do this. The results were based on a systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources. The comparison exposes and contrasts two basic generic modes of commissioning:

  1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers.
  2. Case-mix commissioning (Germany), in which managerial performance, an ‘episode based’ negotiated order and juridical controls appear the dominant media of commissioner power.

He argued that governments do not necessarily maximise commissioners’ power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners’ use of provider competition as a means of control. Download slides [pdf] >>

Dr Lesley Wye (Centre for Primary Care at the University of Bristol) presented preliminary results from one of the threads of a three year study exploring knowledge exchange between external providers (both commercial and not for profit) and clinical commissioners. This focused on the introduction of a risk prediction tool and commissioning decision making around avoidable hospital admissions. Although this was one story of many, it illustrated findings on the role of external providers, the ‘knowledge’ that is on offer and the approach of clinical commissioners to information, both research based and from other sources. Download slides [pdf] >>

Finally Dr Erica Gadsby (Research Fellow at the Centre for Health Services Studies at the University of Kent and researcher with PRUComm) presented the findings of a recent review of international evidence on personal budget-type programmes in health and social care, and looked at where the English programme sits in relation to others around the world.  It examined the key motivations behind such programmes, and what the evidence and wider literature says about the extent to which Personal Budget programmes meet expectations. Download slides [pdf] >>

Health Policy & Politics Network (HPPN) 2012 Annual Conference

3-4 September 2012
Magdalen College, University of Oxford

The Health Policy & Politics Network (HPPN) is successor to the Politics of Health Group that has been run for the last 20 years or so in the form of a special interest group of the Political Studies Association. HPPN has now become independent in order more easily to encourage interdisciplinary working. HPPN aims to provide a forum for the reporting of research and analytical discussion about any aspect of the politics of health, health care policy or health services management and to facilitate the development of informal and collaborative relationships between academics and interested practitioners working in the above fields.

We invite submission of paper presentations to this event on any topic related to  health politics, policy or management. Papers may be research papers, and for these speakers will be allocated 20 minutes plus 10 minutes for discussion/questions, or policy reports/analysis papers which will be tabled and discussed. Please indicate your paper type when sending in a title and short abstract.


Diversity of provision of public services symposium: current research and its implications

London School of Hygiene & Tropical Medicine
Friday, 13th April 2012

Symposium programme

Pauline Allen  convened the symposium  to discuss recent developments in the delivery of public services. Using the government’s recent White Paper ‘Open Public Services’ (2011) as a starting point ,  the  increasingly diverse range of providers of public services was discussed.  In fact, this policy is not new – the previous New Labour government had been encouraging the entry of different providers to various public services. The symposium  provided an opportunity to explore and compare rationales, processes and results of increasing diversity of provision within different areas of the public sector and to assess the implications for the performance of public services.

One of the contributions was from Imelda McDermott, dealing with the increasing diversity of providers of primary health care services.

Health Policy & Politics Network (HPPN) 2012 Spring Event

The Health Policy & Politics Network (HPPN) is successor to the Politics of Health Group that has been run for the last 20 years or so in the form of a special interest group of the Political Studies Association. HPPN has now become independent in order more easily to encourage interdisciplinary working. HPPN aims to provide a forum for the reporting of research and analytical discussion about any aspect of the politics of health, health care policy or health services management and to facilitate the development of informal and collaborative relationships between academics and interested practitioners working in the above fields.


Department of Health Policy Research Units

On Tuesday 31st January, PRUComm Director Stephen Peckham and Deputy Director Kath Checkland attended a meeting for all the heads of the new Department of Health Policy Research Units. PRUComm is one of 11 such units, funded until December 2015. This was an opportunity for the researchers involved to get together to discuss their experiences over the first year of the programme, hosted by the Department of Health. The meeting was well attended, and there were useful presentations from senior policy staff from the Department of Health, as well as an introduction from the Chief Medical Officer, Professor Dame Sally Davis. In the afternoon, representatives from some of the units provided some insights based upon some of their experiences so far. Overall this was an invaluable opportunity to share notes with other researchers and to make more informal contacts with our Department of Health ‘customers’.

PRUComm research seminar on healthcare commissioning

On Tuesday 17th January, PRUComm hosted a Commissioning Seminar, bringing together academics with policy makers from the Department of Health in order to discuss research evidence relevant to Commissioning. In addition to the formal presentations which brought together early evidence from a number of ongoing projects, the seminar provided an excellent opportunity for policy makers and researchers to discuss their concerns, needs and issues in an informal environment. PRUComm is committed to ensuring that their research is relevant to the concerns of policy makers, whilst adhering to the highest academic standards, and this seminar was one of a series that will be organised over the coming years to provide a forum within which ideas can be shared in a supportive environment.