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Commissioning is the process by which health and care services are planned, purchased and monitored. Here we look at the commissioning process in more detail, the organisations involved and how it is changing.

What is commissioning?

Commissioning comprises a range of activities, including:

  • assessing needs
  • planning services
  • procuring services
  • monitoring quality.

The process, which is repeated typically on an annual basis, is often shown as a cycle:

Diagram of NHS commissioning cycle

Image courtesy of NHS England

The concept of commissioning was introduced into the NHS in the early 1990s, when reforms separated the purchasing of services from their delivery, creating an ‘internal market’. It was argued that making providers compete for resources would encourage greater efficiency, responsiveness, and innovation.

Who is responsible for commissioning?

Clinical commissioning groups

Approximately two-thirds of the NHS commissioning budget (£73.6 billion in 2017/18) is allocated to local clinical commissioning groups (CCGs).  When they were first established in 2013, there were 211 CCGs, but over time the number has changed and is continuing to change, as described in the section on joint commissioning below.

CCGs have a statutory responsibility for commissioning most NHS services including urgent and emergency care, acute care, mental health and community services. Increasingly they are also involved in commissioning primary care and some specialised services.

CCGs are groups of local GP practices whose governing bodies include GPs, others clinicians such as nurses and secondary care consultants, patient representatives, general managers and – in some cases – practice managers and  local authority representatives.

NHS England

As well as providing strategic oversight for the NHS, NHS England is responsible for directly commissioning some services. This includes specialised services, such as renal dialysis, neonatal services and treatments for rare cancers, and primary care, including GPs, pharmacists and dentists – although increasingly this responsibility is being shared with CCGs (see below). NHS England also commissions some public health services, such as immunisation and screening programmes, as well as health care for people in prisons and secure units and some services for the armed forces. NHS England’s total spending on direct commissioning in 2016/17 was £25.4 billion.

NHS England currently delivers its commissioning function through four regional teams, supported by ten local commissioning hubs.

NHS England is also responsible for assuring the quality of CCGs through an annual assessment process.

Local authorities

Local authorities are responsible for commissioning publicly funded social care services. This includes services provided to people in their own homes as well as residential care services. In 2016/17, local authorities spent approximately £15 billion on adult social care.

Since 2013, local authorities have also been responsible for commissioning many public health services including sexual health services, health visitors, school nursing and addiction services (as mentioned above, some public health services are commissioned by NHS England). Since 2013 funding allocated to local authorities for public health services has been ring-fenced, and this is set to continue until 2019. In 2017/18, the public health grant to local authorities was £3.3 billion.

In addition, health and wellbeing boards, formal committees of local authorities that bring together local authority and NHS representatives, are responsible for carrying out a joint needs assessment  with CCGs and developing a joint health and wellbeing strategy for their local population.

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