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Essay: Commissioning

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  • Subject area(s): Health essays
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  • Published: 13 September 2015*
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  • Words: 872 (approx)
  • Number of pages: 4 (approx)

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Background:
According to the United Kingdom’s Department of Health (DOH) (2007), ‘commissioning is the means to secure the optimum value for local citizens. It is the process of translating aspirations and need, by specifying and procuring services for the local population, into services for users which delivers and provides best possible health, well-being outcomes, and equality and within the best use of available resources’.
Gupta (2011) defines commissioning as the process of assessing the needs of a localized population and putting in place services to meet those needs and that a huge range of knowledge, skills and attitudes are a requirement for effective commissioning. DOH (2007) further explains commissioning as a means of assisting local people to take ownership of their health, actively contributing to their communities. Furthermore, to have a choice with easy access to the service they need, understand and expect future needs promoting health and support self-determination. In 2007, the World Class Commissioning (WCC) Programme was launched, which was meant to drive up the commissioning potential of local NHS commissioners. This introduced set of eleven competencies that set out knowledge skills, behaviours and qualities commissioners needed to possess. Gupta (2011) also argues that the knowledge, skills and attitudes needed for effective GP commissioning, although some are similar to WCC framework.
According to the Royal College of Practitioners’ (RCGP), healthcare commissioning must be based on improving outcomes for patients and communities, giving patients the power to shape their personal health care, evidence-based assessment of needs, seeking to harness the power of communities to determine their personal health outcomes and a commitment to sustainable use of resources. The RCGP’s commissioning framework further outlines the need to have commissioners and how they can be competent and effective. The framework contains five main competency domains: like leading people, Leading a consortium, serving the community and leading commission and leading improvement and innovation (NHS, 2011).
The general steps of the healthcare commissioning process can be argued through NICE (2010) like: Firstly, assessing the healthcare needs of the local population and its citizens, and reviewing how well the provision of existing services meets those needs. A five step model proposed by NICE (2005) is used to assess the needs of the community. The second step in the process is identifying the priorities for investment and services, and identifying the services to meet these priorities. Thirdly, Acquiring these services through contracts with a variety of service providers, including General Practitioners, NHS trusts, foundation trusts, third sector and independent sector organizations. At last process ensures that the services are provided effectively, and monitor quality and outcomes.
The World Class Commissioning framework (2010), states that commissioning is a cyclical process. The World Class Commissioning (WCC) cycle includes three main stages of Planning, Procurement and Monitoring and several sub-stages, each of which will require the all the competencies and principles as shown in the Figure below.
Planning phase has four stages of Assessing Health Needs after Reviewing current provision Capacity planning, Identifying gaps and priorities. Procurement in WCC cycle is a Phase of the commissioning cycle when the commissioner decides how to obtain a service. Procurement is ‘the process of identifying a supplier within an environment of open competition to deliver best value’ (Department of Health, 2007a). Often, this happens through a well recognized ‘competitive tender process. , open procurement, restricted procurement and competitive dialogue are other options for bidding. The whole process as by the state Department of Health (2010) should follow the principles of transparency, proportionality, non discrimination, and equality of treatment. Procurement also follows four stages in the WCC cycle, as above in the figure 1. In monitoring and evaluation, commissioners need to vigorously monitor activity and budgets and it also consists of four stages.
Commissioning in Healthcare 2013 in the UK:
On 12th July 2010, Andrew Lansley (the UK’s Secretary of State for Health) presented a new health White Paper named ‘Equity and Excellence: Liberating the NHS’ and describing significant structural changes to the NHS under the Conservative and Liberal Democrat coalition government. This later became the Health and Social Care bill which received royal consent on March 2012 and was endorsed as the Health and Social Care Act 2012 (Department of Health, 2012).
In April 2013 the Health and Social Care Act 2012 come into full effect. With this, NHS England (formerly the NHS Commissioning Board) gained full constitutional powers, all 211 Clinical Commissioning Groups (CCGs) became authorised by replacing Primary Care Trusts (PCTs), and 152 Health and Wellbeing Boards took position, tasked with providing strong representation for local communities (Figure 2) (Department of Health, 2012). In the reformed NHS landscape, the power to commission services has been transferred to the CCGs who decide which services their communities require. With this commissioning reform, the health care system looks to ensure local health care is more patient driven and has a focus on improving health outcomes for the population (The NHS’ Information Centre for Health and Social Care, 2011).
The public health function transferred from the PCTs to the local governments under the propitious of Health and Wellbeing Boards (HWBs). In Public Health England at the national level it’s crucial that CCGs are full and active members of their local HWBs. The HWBs can make a significant constructive input towards dealing with the wider determinants of health by joining forces with all the local government

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