This includes a wide range of services, from emergency and urgent care through to infertility services and maternity and newborn provision. NHS England is responsible for making sure that all NHS organisations discharge their commissioning responsibilities appropriately, and also work closely with CCGS and a range of other providers on specialist commissioning services. Whereas CCGs will typically commission services for a clearly defined local geographical area and population, specialist services often cover large regional or national networks due to only being required by a small section of the overall population.
At present specialist commissioning includes a number of different areas such as the provision of all aspects of care and laboratory testing facilities that relate to haemophilia. Specialist commissioners in areas such as haemophilia also work closely with other specialist areas such as genetic services, and they are advised by Clinical Reference Groups CRGs who provide specific clinical guidance and expertise on the best way in which services should be structured and delivered.
CRGs are comprised of clinicians, commissioners, public health experts and patients. NHS England, working closely with Public Health England, is also responsible for the commissioning of all screening and immunisation services within England, with a total budget of 1. NHS England also has commissioning responsibility of a number of highly specialised public health services, working closely with a wide range of other commissioning organisations to cover areas such as tuberculosis control, dental screening and oral health improvement.
It also has oversight of the Cancer Drugs Fund that was established in to provide additional funding for cancer medication that is not routinely available on the NHS for all patients. The fund also provides additional capital for standard operating procedures, and allows cancer specialists to make individual requests for specialist treatment for rarer types of cancer, including those affect children.
In some places, devolution is being used to support system-wide approaches to commissioning. The most prominent example of this is Greater Manchester , where CCGs, local authorities and other local bodies have come together to take responsibility for the entire local health and care budget. Other areas, including Surrey Heartlands , London and Cornwall have also agreed devolution deals, but they are not on the same scale as the Greater Manchester deal.
There are also examples of providers taking on a greater role in commissioning and it is likely that as new integrated provider models develop, this will start to happen more frequently. For example, in some parts of the country, NHS England has devolved commissioning responsibility and budgets direct to provider organisations for specialised mental health services, for example, some child and adolescent mental health services.
Since , commissioners and providers have been working together to develop new care models that bring together local NHS organisations from different parts of the health system to provide a range of services and deliver more integrated care for patients.
This may lead to commissioners taking a more strategic role in overseeing the local health system, focusing more on overall performance and less on individual services. Within these systems, providers may also take on some activities currently carried out by commissioners, such as service development and sub-contracting for and monitoring the performance of individual services. CCGs within ICSs are working through what services and activities should be conducted at different levels in future.
Since the Act came into force, there have been a number of changes to the way that commissioning is delivered in practice. There is a trend towards a system-wide approach in which tasks previously conducted by individual commissioning organisations are starting to be undertaken collaboratively. This more integrated approach to commissioning mirrors the more integrated approach to delivering health and care services that has been developing for some time.
Local areas are being encouraged to develop arrangements that suit their local circumstances, rather than these being directed centrally. It is likely that as these models develop, more CCGs merge and the shift towards ICSs in particular gathers pace, the way commissioning is delivered and the role of CCGs will continue to evolve. As a patient I am despairing of the treatment I am receiving, my GP has her hands tied, cannot prescribe the treatment I need, so I self source and we both shake our heads at the inanity of it all.
Patients are being sacrificed. Too many of my friends are going 'private' in order to feel well.. Pushing patients who need 'normal' medicine to private practice is not on the NHS Balance Sheet as a consequence of reducing budgets. It should be!! Could we have a comparison with the parts of the nhs that do not have this structure, Wales and Scotland?
And how do concepts like person centred fit? What is commissioning? Commissioning comprises a range of activities, including: assessing needs planning services procuring services monitoring quality. The process, which is repeated typically on an annual basis, is often shown as a cycle:. Who is responsible for commissioning? Local authorities Local authorities are responsible for commissioning publicly funded social care services.
Commissioning support organisations Support for commissioning activities is available from commissioning support units CSUs and a range of private and voluntary sector organisations.
How is commissioning changing? Specialised services NHS England recently set out plans to give local systems rather than just commissioners a greater say in how the specialised commissioning budget is spent in their area. Joint or integrated commissioning CCGs CCGs are increasingly working together to commission services across their local populations and deliver economies of scale.
CCGs and local authorities Many CCGs and local authorities are also working together to support more integrated health and social care. Devolution In some places, devolution is being used to support system-wide approaches to commissioning. Providers and commissioning There are also examples of providers taking on a greater role in commissioning and it is likely that as new integrated provider models develop, this will start to happen more frequently.
Related content. Paid event Thinking differently about commissioning. Topic Commissioning and contracting: Our work on the ways in which NHS, health and care services are commissioned and purchased. Topic Clinical commissioning groups: Our work on CCGs — clinically-led bodies responsible for planning local health and care services. Completed project Thinking differently about commissioning: new approaches to local planning This project sought to support systems as their commissioning structures evolve by presenting evidence to inform decision-making.
Our governing body, including its sub-committees, as well as our clinical commissioning executive help us finalise decisions and play a key role in holding us to account publicly.
In addition to this we have a number of patient groups giving local patients and the wider public a chance to scrutinise any decisions we make. Before we make any changes to services we have a responsibility to involve and consult with our patients and the wider public. You can see our latest consultations as well as other opportunities for you to get involved in the work we do by visiting our get involved pages.
As a membership led organisation we work closely with our 99 member practices who help us by providing the day to day clinical knowledge and have their say on any proposed commissioning plans. There are also a number of national policies we have to follow as well as ensuring that we meet our duties as set out in the Health and Care Act and the legally binding NHS Constitution.
The strategy has been developed following a process called the Joint Strategic Needs Assessment JSNA which has helped identify key priorities and areas of action for the city so that we can improve the health and wellbeing of our communities.
As a CCG we also have a range of policies in place to ensure that we follow the same process for commissioning services. For more expensive and rare treatments a patient may need to be subject to our individual funding request policy. Commissioning is the term used in the public sector for planning and buying services.
It is a structured way of deciding how public money should be spent. In the case of the NHS, commissioning relates to providing health services.
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