NHS commissioning practice and health system governance: a mixed-methods realistic evaluation
Sheaff R, Charles N, Mahon A, Chambers N, Morando V, Exworthy M, Byng R, Mannion R, Llewellyn S
Record ID 32015000520
English
Authors' objectives:
To: elicit the programme theory of NHS commissioning policy and empirically test its assumptions; explain what shaped NHS commissioning structures; examine how far current commissioning practice allowed commissioners to exercise governance over providers; examine how commissioning practices differ in different types of commissioning organisation and for specific care groups; and explain what factors influenced commissioning practice and the relationships between commissioners and providers.
Authors' recommendations:
Commissioning practice worked in certain respects differently from what NHS commissioning policy assumed. It was often laborious and uncertain. In the four English case study sites financial and 'real-side' contract negotiations were partly decoupled, clinician involvement being least on the financial side. Tariff systems weakened commissioners' capacity to choose providers and control costs. Commissioners adapted the systems to solve this problem. Our findings suggest a need for further research into whether or not differently owned providers (corporate, third sector, public, professional partnership, etc.) respond differently to health-care commissioners and, if so, what specific implications for commissioning practice follow. They also suggest that further work is needed to assess how commissioning practices impact on health system integration when care pathways have to be constructed across multiple providers that must tender competitively for work, perhaps against each other.
Details
Project Status:
Completed
Year Published:
2015
URL for published report:
http://www.journalslibrary.nihr.ac.uk/hsdr/hsdr03100/#/abstract
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
England, United Kingdom
MeSH Terms
- State Medicine
- National Health Programs
Contact
Organisation Name:
NIHR Health Services and Delivery Research programme
Contact Address:
NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name:
journals.library@nihr.ac.uk
Contact Email:
journals.library@nihr.ac.uk
Copyright:
Queen's Printer and Controller of HMSO
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