Improving commissioning of health and care services

What is commissioning?

Commissioning is the process of identifying the services required for a given area or population, and procuring them. NHS England describes commissioning as follows :

“At its simplest, commissioning is the process of planning, agreeing and monitoring services. However, securing services is much more complicated than securing goods and the diversity and intricacy of the services delivered by the NHS is unparalleled.

Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.”

Commissioning is therefore a key process in the health and care system as it determines which services will be available and how they will be provided.

Clinical commissioning

The majority of health and care services are commissioned by local Clinical Commissioning Groups (CCGs), which replaced now-defunct Primary Care Trusts following the 2012 Health and Social Care Act. CCGs have the primary responsibility for ensuring that services are provided to meet the health needs of their local population.

Work of the Neurological Alliance on clinical commissioning

Unfortunately, services for people with neurological conditions have a long history of being under-prioritised and overlooked by clinical commissioners. At the Neurological Alliance we hear too many stories of low-quality, fragmented services, lack of communication, and poor planning.

Consequently we sent a Freedom of Information request to every CCG and surveyed almost 7,000 people with neurological conditions to better understand the reality ‘on the ground.’ The results were striking:

  • Only 14.7% of CCGs have assessed local costs relating to the provision of neurology services
  • Only 20.4% and 26.2% of CCGs have assessed the number of people using neurological services and the prevalence of neurological conditions within their area respectively
  • Only 33% of CCGs obtain vital feedback from patients in regards to the neurological services they commission
  • These issues have a significant impact on patients’ care, with 58.1% of patients having experienced problems in accessing the services or treatment they need.

It is clear that CCGs have much to do to improve commissioning of neurology services, and the Neurological Alliance will continue to work to drive improvement. The full findings and recommendations are available in our report, The Invisible Patients: Revealing the State of Neurology Services

Specialised commissioning

Specialised commissioning refers to services which are currently commissioned centrally by NHS England on grounds of rarity and cost. From April 2015, NHS England will begin to move towards co-commissioning arrangements with CCGs for commissioning specialised services.

Work of the Neurological Alliance on specialised commissioning

Specialised commissioning for neurology suffers from a degree of confusion over the boundary between specialised and non-specialised services. This results from contradictory guidance produced by NHS England, leading to confusion over where responsibility lies for certain services. This has led to situations where neither NHS England nor CCGs are willing to take on responsibility for certain services, leaving patients under-served. The Alliance continues to press for a revision to the guidance produced by NHS England, particularly the Neurosciences Service Specification. We explain this issue in more detail in a briefing which can be read and downloaded here.

The Neurological Alliance is also working closely with stakeholders including NHS England and the Neurosciences Clinical Reference Group (of which it is a member) on the introduction of co-commissioning for neurology, in order to ensure that the proposed changes work in the interests of patients.

Supporting local influencing of commissioners

In order to improve standards of local commissioning, the Alliance works to support local campaigners and advocates to engage with CCGs, local authorities and other local agencies. See more information about this workstream here

Back to top