With the move towards accountable care, clinical commissioners are starting to take on a more strategic role as they plan and purchase health care for patients – a transition which comes with opportunities but is not without challenge.
Our briefing, making strategic commissioning work: lessons from home and away, aims to support the evolution of a more strategic commissioning function.
The publication brings out lessons based on evidence from the UK and health systems abroad. These are drawn from the perspectives of those implementing and developing policy around the new care models and from research of international models, primarily of high performing place-based systems of care that have developed in New Zealand, Sweden, Spain and the United States.
Recommendations from making strategic commissioning work: lessons from home and away include:
The patient must be placed at the centre with a focus on quality – targets, payment incentives and prescriptive regulation have proved largely unsuccessful in driving system improvement and ensuring financial sustainability.
Clinical commissioning leadership and engagement must be retained – the evidence shows that success of population level planning is reliant on the engagement of clinicians in primary, secondary and community care, as well as the wider workforce.
National clarity on the ‘end state’ is essential – while local areas must lead the development of models for integrated health and care delivery, internationally, no system has been implemented without clear political consensus and a legislative framework to support it on an ongoing basis. In the UK, this could mean a national framework is needed – provided this is not too prescriptive to limit local development.
Supporting strategic commissioning at national and local levels
The briefing also shows ways that national bodies can support the transition to strategic commissioning including sharing learning around the design and development of accountable care models, working with local areas to map the risks and challenges of accountable care models so they can be mitigated, and developing strategic commissioning skills and capacity.
Local enablers to strategic commissioning include taking a person-centred approach, and ensuring mechanisms are in place to ensure accountability to the local population and clinical community.
We used a number of sources to inform this publication. See the full list of references.
International case studies
The publication was in part informed by desk-based research on international examples of high performing place-based systems of care in New Zealand, Sweden, Spain and the United States.