부산대학교 도서관

Chapter 5 reports research on the more recent policy of allowing CCGs to commission primary care services. In 2014 CCGs were invited to volunteer to take on responsibility for commissioning services from their member GP practices in addition to their wider responsibilities for commissioning acute and community services. In this chapter we explore the history of primary care commissioning and financing in England, and discuss the broad policy objectives which underpinned this significant change in CCGs role and scope. These objectives include the need to move to a ‘place-based’ approach to commissioning, and the need for a more effective linkage between the commissioning of primary and secondary care services in order to support movement of services into the community. Over time, most CCGs have moved to take on full delegated responsibility for commissioning GP services, and have established functioning primary care commissioning committees, with little evidence of significant problems associated with conflicts of interest. The development of local additional ‘quality contracts’ and investment in infrastructure and premises have been important issues, with few CCGs seeking to establish larger scale contractual changes. There have been significant local legacy issues in some areas relating to unclear contracts and poor handover of responsibilities from NHS England. The current legislation, under which statutory responsibility for commissioning primary care services remains with NHS England and is delegated rather than transferred to CCGs, presented some problems, particularly for those CCGs who wished to work together across a broader geographical footprint.
This book brings together selected research on commissioning healthcare in the English NHS carried out by national policy research unit in commissioning and the healthcare system (PRUComm) between 2011 and 2018. PRUComm is funded by the English Department of Health’s Policy Research Programme. The bookexplores the changes to commissioning in the English NHS quasi market introduced by the Health and Social Care Act 2012 (HSCA 2012). It focuses on threemain areas: first, the development and operation of the newly formed commissioning bodies named Clinical Commissioning Groups (CCGs) which were supposed to increase clinical engagement; secondly, technical aspects of commissioning being the use of competition and cooperation by CCGs to commission care in the HSCA 2012 regulatory context encouraging competition,and the allocation of financial risk through contracts between commissioners and providers of care (including new forms of contract such as alliances); and thirdly the reorganisation of the commissioning of public health services. The research demonstrates that the HSCA 2012 has had the effect of fragmenting commissioning responsibilities and in the process impaired good governance and strong accountability of commissioners. It shows how the use of market mechanisms has declined despite the pro competition regulatory regime of the HSCA 2012, and that more cooperative processes are used at local level to reconfigure health services. It concludes that strategic planning and monitoring of services will always be essential for the English NHS, whether the term ‘commissioning’ is used to describe these activities or not in the future.This timely book is the most comprehensive account yet of recent commissioning practice in the English NHS and its impact on health services and the healthcare system.Drawing on eight years of research, expert researchers in the field analyse crucial aspects of commissioning, including competition and cooperation, the development of Clinical Commissioning Groups and contractual mechanisms. They also consider the influence of recent commissioning reforms on public health infrastructure.For academics and policy makers in health services research and policy, this is a valuable collection of evidence that deepens understanding of how commissioning works.This timely book is the most comprehensive account yet of recent commissioning practice in the English NHS and its impact on health services and the healthcare system.