Where next for commissioning inthe NHS?Nuffield Trust Annual Summit 2011Judith SmithMarch 2011                          © ...
‘Weaknesses remain, 20 years after the introduction of the purchaser- provider split. Commissioners continue to be passive...
‘There is little substantive research evidence to demonstrate that any      commissioning approach has made a significant ...
‘Purchasing health services is inherently difficult in publicly financed      health systems.’      (Mays and Hand, 2000)M...
Commissioning: a peculiarly English obsession?• A term we use in the NHS in England for what others call  strategic purcha...
And we seem committed to its retention...                                                       Purchaser-                ...
Research points to a common set of problems:• Asymmetry of information between providers and funders• The power lies with ...
Evidence on primary care-led commissioning•It is effective in developing primary and intermediate care•This happens throug...
The current context makes things more difficult• Economic hard times, where tough funding (rationing)  decisions need to b...
Choice of levers to achieve efficiency savings                                               More provider competition    ...
Questions for us to ponder• We are putting huge faith in GP commissioning – what will  be needed if these reforms are to d...
www.nuffieldtrust.org.uk       Sign-up for our newsletter       www.nuffieldtrust.org.uk/newsletter       Follow us on Twi...
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Judith Smith: Where next for commissioning in the NHS?

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Judith Smith: Where next for commissioning in the NHS?

  1. 1. Where next for commissioning inthe NHS?Nuffield Trust Annual Summit 2011Judith SmithMarch 2011 © Nuffield Trust
  2. 2. ‘Weaknesses remain, 20 years after the introduction of the purchaser- provider split. Commissioners continue to be passive, when to do their work efficiently, they must insist on quality, and challenge the inefficiencies of providers, particularly unevidenced variations in clinical practice.’ (Health Select Committee Inquiry, 2010, p38)March 2011 © Nuffield Trust
  3. 3. ‘There is little substantive research evidence to demonstrate that any commissioning approach has made a significant or strategic impact on secondary care services’ (Smith, Mays, Dixon, Goodwin et al, 2004)March 2011 © Nuffield Trust
  4. 4. ‘Purchasing health services is inherently difficult in publicly financed health systems.’ (Mays and Hand, 2000)March 2011 © Nuffield Trust
  5. 5. Commissioning: a peculiarly English obsession?• A term we use in the NHS in England for what others call strategic purchasing, paying, or planning and funding• Linking available funding to services provided has to be done somehow• We have chosen, for 20 years, to do this via a purchaser- provider splitMarch 2011 © Nuffield Trust
  6. 6. And we seem committed to its retention... Purchaser- 8% provider split should be retained Purchaser- 29% provider split should be 63% abandoned Dont know Source: The Nuffield Trust: A Snapshot Survey of Health Leaders on the Government’s NHS Reform (Forthcoming)March 2011 © Nuffield Trust
  7. 7. Research points to a common set of problems:• Asymmetry of information between providers and funders• The power lies with (especially hospital) provider institutions• Sorting out budgets and financial risk• Securing high quality commissioning support• Ensuring proper accountability for funding decisions, service quality and outcomesMarch 2011 © Nuffield Trust
  8. 8. Evidence on primary care-led commissioning•It is effective in developing primary and intermediate care•This happens through peer review, clinical governance,development of care pathways, control of referrals•It can lead to improved responsiveness on the part ofsecondary care•There is little evidence to show that it is effective in makingstrategic changes to secondary careMarch 2011 © Nuffield Trust
  9. 9. The current context makes things more difficult• Economic hard times, where tough funding (rationing) decisions need to be made• We assert a need for more preventative and population health-focused care (less reliance on hospitals)• We are again reorganising commissioning (as we did in 1999, 2002, and 2006)• The leaders’ survey suggests more faith in central and local performance management, than in GP commissioningMarch 2011 © Nuffield Trust
  10. 10. Choice of levers to achieve efficiency savings More provider competition 13% 26% stronger central performance management 13% stronger local performance 1% management GP commissioning 47% Control of prices for clinical care Source: The Nuffield Trust: A Snapshot Survey of Health Leaders on the Government’s NHS Reform (Forthcoming)March 2011 © Nuffield Trust
  11. 11. Questions for us to ponder• We are putting huge faith in GP commissioning – what will be needed if these reforms are to deliver the efficiency challenge?• What will be the role of the NHS Commissioning Board in relation to GP commissioning?• What about the other commissioners of health: local government, people holding personal budgets?• Do we need to move beyond commissioning?March 2011 © Nuffield Trust
  12. 12. www.nuffieldtrust.org.uk Sign-up for our newsletter www.nuffieldtrust.org.uk/newsletter Follow us on Twitter (http://twitter.com/NuffieldTrust)March 2011 © Nuffield Trust
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