Understanding the new commissioning system in England
Understanding the new commissioning system in England: context, mechanisms and outcomes
Duration of Study in the UK
2 years, 11 months, 25 days
The ‘new NHS’ established by the Health and Social Care Act 2012 aims to move away from the previous ‘top down’ approach to system management via the establishment of an arm’s-length commissioning body, NHS England, and empowering local clinicians through their membership of Clinical Commissioning Groups (CCGs).
However, change of this magnitude also brings with it some issues. Firstly, the new system is structurally more complex than previous arrangements. Whilst previous organisations with commissioning responsibilities were generally largely comparable in terms of population coverage, CCGs vary greatly in size, complexity and their relationship to previous commissioning organisations. Furthermore, the new system has created many new organisations which will need to work together. This study will therefore explore how this complex landscape is being negotiated.
Secondly, the new system is more complex in the way that it operates. Whereas previously Primary Care Trusts held complete responsibility for commissioning virtually all the care required by their local geographical populations, commissioning responsibilities for local populations are now divided between a number of different organisations. It is therefore important that research explores the relationship between these new commissioning bodies, investigating the ways in which commissioners with different areas of responsibility are interacting and negotiating their new roles.
Thirdly, the new system carries with it a complex web of accountability relationships, with new local mutual accountabilities as well as accountability to NHS England and other national-level bodies. It will be important to understand how any potentially conflicting accountabilities are unfolding across these levels. This study will therefore investigate how the reforms are playing out in practice, and will explore the impact of the new structural and operational complexity on system operation and outcomes.
In short, this research seeks to explore this complexity and generate knowledge about the development of the new commissioning system.