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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This is a review of the literature on primary care physician (Eg family doctor, general practitioner or other generalist working in a community setting) payment, methods and their impacts on physician behaviour. This report was commissioned by the Department of Health to provide background evidence to support policy development on primary care and the impact of payment structures.
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By Anna Coleman and Julia Segar
A recent publication by the New Local Government Network (NLGN) looked at how local councils are preparing for the future and suggests depressingly that“there is simply no way that local government can reach 2018 let alone 2020 while still delivering the full range and quality of services currently on offer”(p6).
Simply put, we have an ageing population, with associated increasing demand for care services and draconian cuts in council budgets. The NLGN suggest we could be facing a future of “private affluence and public squalor”. However, it is not all doom and gloom. Perhaps austerity can be a strong stimulus for innovation? How would this work I hear you ask?
By Anna Coleman
A great deal rests on Health and Wellbeing Boards (HWBs), a new type of local partnership. These were established under the Health and Social Care Act 2012, to act as a forum in which leaders from the local health and care system could work together to improve the health and wellbeing of their local population and promote integrated services.
Last year, the House of Commons Communities and Local Government (CLG) Committee concluded that HWBs have a pivotal role and their success ‘is crucial to the new arrangements’. However, it also warned of the danger ‘that the initial optimism surrounding their establishment and first year or two in operation will falter and go the way of previous attempts at partnership working that failed and became no more than expensive talking shops’ (House of Commons CLG Committee, 2013 paragraph 22, 14). We examine these issues and the early development of HWBs in our recently published article in Local Government Studies.
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