What can we learn from other countries about integrating strategic commissioning?

Strategic commissioning involves more than deciding whether to deliver services in-house, in-partnership or externally; it focuses on managing and using markets to secure desired outcomes.

he need to deliver real and sustainable improvements in quality means that local systems need to identify better ways to commission services.

To achieve this, local health system leaders need to respond to three fundamental and interrelated questions:

  • What are the health and care needs of the population and which of these are a priority?
  • How do we organise ourselves so that our resources are allocated effectively to meet these needs?
  • What is the most effective and efficient mode of delivery given our priorities and resources?

For health systems to be able to effectively answer these questions, they must bring together the clinical expertise and knowledge of clinical commissioning groups (CCGs) and NHS providers, with other partners across the system.

Many people are wondering how this will work. What type of contract will accountable care systems operate? How will this replace the current forms of contracts across the system?

Strategic commissioning will continue to look at the funding and planning of services as well as holding providers to account for the delivery of agreed outcomes. However, the commissioning process will need to focus on defining and measuring outcomes through the use of alternative mechanisms such as place-based capitated budgets.

To help us understand how this works in practice, we can look at the accountable care models approach in the USA.

Their experience of new models of working and integrated care was shared by Dr Rachael Addicott of The King’s Fund at one of SCW’s Best Practice events in 2015.

Her key messages provided valuable lessons to inform developments in the UK:

› High performing integrated systems use capitated budgets for almost all care 
› There is a need to align commissioner and provider budgets
› Their main focus is on population-based budgets, not disease- or condition-based budgets
› They also specify the quality/outcomes they expect to be delivered, and emphasize that rather than activity.

Studies of these American models found three contract elements needed to encourage more integrated care and partnership working:

› Service integration can only be achieved by providers, the people delivering the services, actually working together in a streamlined way
› There is a need to hold providers to account for delivering outcomes
› Payment mechanisms must be aligned so that all parties involved are incentivised in the same way.

These elements needed to be support by:

› Engagement with providers, patients and wider communities to agree the problem, what needs to be achieved, what the service will look like in the future, and if there is a need for a contractual solution and a new organisational model to support that
› Relational approaches as well as transactional ones – it’s more than just the contract. The relationships around it are also important
› Focus on building governance structures and processes – how will the new entity work in practice, how will they make decisions collaboratively.

SCW is able to support customers to develop their strategic commissioning. We ask the questions needed to decide and deliver the appropriate direction for local systems. We have supported customers with mergers and organisational development such as supporting the two CCGs in Buckinghamshire as they merged into a single organisation. We also supported the commissioners in North Somerset and Oxford to identify their future commissioning intentions for the local hospital services. We would be pleased to answer your questions about strategic commissioning and work with you as you shape your systems.

For more information, contact Louise Tranmer, Director leading our work in strategic commissioning.

Director of Transformation