Positive progress has been made towards collaborative commissioning at system level

Driving ForwardNHS trusts and commissioners have a strong appetite for working together more collaboratively to improve the way they deliver services for their local populations, according to the membership bodies representing both clinical commissioners and providers.

A joint report from NHS Clinical Commissioners and NHS Providers finds that although progress is at an early stage, the relationship between commissioners and providers is on the brink of significant change. Building on NHSCC’s 2017 publication Steering towards strategic commissioningDriving forward system working: a snapshot of early progress in collaborative commissioning finds that commissioners are beginning to take a more strategic approach, commissioning for outcomes across larger population footprints, with trusts taking on or supporting activities previously undertaken by clinical commissioning groups (CCGs) such as developing pathways and service specifications.

Driving forward system working: a snapshot of early progress in collaborative commissioning is based on interviews with leaders from CCGs, NHS trusts, national policy makers and think tanks and explores the changing relationship between commissioners and providers in the context of system working.

The report finds that while there is no single best approach to deliver collaborative commissioning, a number of common success factors are already facilitating system working:

  • Strong collaborative and clinical leadership that transcends organisational boundaries and is focused on delivering care to meet the needs of a local population.
  • Establishing ‘one version of the truth’ that can drive honest open and honest conversations.
  • Supporting staff to work flexibly across systems, potentially pooling resources or appointing joint posts.
  • Involving all system partners, including local authorities and the voluntary and independent sectors.

The report shares practical examples of local areas that have made progress on collaborative system working, such as in Gloucestershire where local authority and CCG staff have access to the same electronic network to share information, and in Devon where a collaboration of mental health providers has succeeded in reducing out of area placements.

Changes at the national level could further enable providers and commissioners to navigate these challenges and collaborate more freely as system partners. These changes identified in the report include:

  • Aligning national policy requirements, such as regulation, financial incentives and assurance processes, with the realities of developments on the ground.
  • Adopting an approach in day to day dealings with local bodies that mirrors the expectations of collaborative working.
  • Offering national guidance and support to help all systems navigate in this new landscape. This involves supporting leadership, supporting risk management and governance arrangements, and continuing to support the sharing of innovative practice.

Photo of Julie Wood, chief executive of NHS Clinical CommissionersJulie Wood, chief executive of NHS Clinical Commissioners, said:

“Whilst the commissioning landscape is undoubtedly evolving the core importance of clinical leadership within the commissioning function remains. With integration of care likely to be a key part of the long term plan for the NHS, and the right thing to do, this timely report highlights the willingness of both providers and commissioners to better work together as system partners through collaborative commissioning in order to deliver excellent care for our patients and populations, and to ensure the sustainability of the NHS.

“We need to learn from the promising examples in the report if we are to succeed in these aims. However, there are some barriers to such system-wide working that need to be overcome, and we will soon be publishing five key asks from our membership to enable and support integration across system and place.”

Miriam Deakin NHS ProvidersMiriam Deakin, NHS Providers Director of Policy and Strategy, said:

“This report provides a helpful and timely snapshot of how the relationship between commissioners and providers is evolving at the frontline, in the context of system working.  As commissioners increasingly seek to work strategically across a larger population footprint, there are opportunities for local partners to develop new collaborative relationships, and for NHS providers to take on some of the activities that CCGs currently deliver.

“Although many of the areas we spoke to were at the early stages of developing new ways of working, we were struck by providers and commissioners’ enthusiasm for a new, collaborative and constructive relationship based on the shared goal of serving their local populations.  Colleagues in the national bodies must now also ensure the policy and regulatory frameworks support this direction of travel by enabling commissioners and providers to work together constructively, within the current legal framework and in support of system working.”

Access an interactive digital version of the report via the NHS Providers website.

Two of the contributors to the report, Dr Chirag Bakhai, deputy clinical chair at Luton CCG, and Dr Gordon Macmillan, assistant director of strategy and business development at The Hillingdon Hospitals Foundation Trust, have co-written an article about their experiences of collaborative commissioning in their local areas. Read the article.
14 December 2018