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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Evaluating the design and implementation of the whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link

Authors: Judith Smith, Gerald Wistow, Holly Holder, Matthew Gaskins

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Commissioning is a term used in the English National Health Service (NHS) to refer to what most health systems call health planning or strategic purchasing. Drawing on research from a recent in-depth mixed methods study of a major integrated care initiative in North West London, we examine the role of commissioning in attempts to secure large-scale change within and between health and social care services to support the delivery of integrated care for people living with complex long-term conditions.

Methods

We analysed data collected in semi-structured interviews, surveys, workshops and non-participant observations using a thematic framework derived both deductively from the literature on commissioning and integrated care, as well as inductively from our coding and analysis of interview data.

Results

Our findings indicate that commissioning has significant limitations in enabling large-scale change in health services, particularly in engaging providers, supporting implementation, and attending to both its transactional and relational dimensions.

Conclusions

Our study highlights the consequences of giving insufficient attention to implementation, and especially the need for commissioners to enable, support and performance manage the delivery of procured services, while working closely with providers at all times. We propose a revised version of Øvretveit’s cycle of commissioning that gives greater emphasis to embedding effective implementation processes within models of commissioning large-scale change.
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Literature
1.
Øvretveit, J. (1992) Purchasing for health gain. The problems and prospects for purchasing for health gain in the 'managed markets' of the NHS and other European health systems. Eur J Pub Health, vol 3 no.2, pp77–84.
2.
Øvretveit J. Purchasing for health: a multidisciplinary introduction to the theory and practice of health purchasing. Maidenhead: Open University Press; 1995.
3.
Department of Health. World class commissioning: vision. London: Department of Health; 2007.
4.
Best A, Greenhalgh T, Lewis S, Saul J, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Millbank Quarterly. 2012;90(3):421–56.CrossRef
5.
The Stationery Office. National Health Service and Community Care Act 1990. London: Stationery Office; 1990.
6.
Ferlie E. The new public management in action. Oxford: Oxford University Press; 1996.
7.
8.
Mawhinney B, Nichol D. Purchasing for health: a framework for action. London: NHS Management Executive; 1993.
9.
Department of Health. The contractors’ companion (2003). London: Department of Health; 2003.
10.
Bovaird T, Dickinson H, Allen K. Commissioning across government: review of evidence. Birmingham: Third Sector Research Centre, University of Birmingham, and National Audit Office; 2012.
11.
Smith JA, Shaw SE, Porter A, Rosen R, Blunt I, Davies A, Eastmure E, Mays N. Commissioning high quality care for people with long-term conditions. National Institute for Health Research: Southampton; 2013.
12.
Sheaff R, et al. NHS commissioning practice and health system governance: a mixed methods realistic evaluation. National Institute for Health Research: Southampton; 2015.
13.
14.
Porter A, Mays N, Shaw SE, Rosen R, Smith JA. Commissioning healthcare for people with long-term conditions: the persistence of relational contracting in England’s NHS quasi-market. BMC Health Serv Res. 2013;13(suppl 1):S2.CrossRef
15.
16.
Figueras J, Robinson R, Jakubowski E, editors. Purchasing to improve health systems performance. Maidenhead: Open University Press; 2005.
17.
Checkland K, Harrison S, Snow S, McDermott I and Coleman A (2012) Commissioning in the English National Health Service: what’s the problem? Journal of Social Policy, vol 41 no.3 pp533–500.CrossRef
18.
Smith JA and Mays N (2012) GP led commissioning: time for a cool appraisal. British Medical Journal vol 344, pp23–25 (published 16 February 2012).
19.
20.
Smith JA, Dixon J, Mays N, Goodwin N, Lewis R, McClelland S, McLeod H, Wyke S. Practice-based commissioning: applying the evidence. Br Med J. 2005;331:1397–9.CrossRef
21.
Checkland K, Coleman A, et al. Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England. British J Gen Pract. 2013;63(614):e614-9.CrossRef
22.
Department of Health. Equity and excellence: liberating the NHS. Cm 7881. London: Department of Health; 2010.
23.
NHS England. NHS five year forward view. London: NHS England; 2014.
24.
Wistow G, Knapp M, Hardy B, Allen C. Social care in a mixed economy. Open University Press; 1994.
25.
Dickinson H. Evaluating outcomes in health and social care. Bristol: Policy Press; 2008.
26.
Wistow G. Still a fine mess? Local government and the NHS 1962 to 2012. J Integr Care. 2012;20(2):101–15.CrossRef
27.
Dickinson H, Glasby J, Nicholds A, Jeffares S, Robinson S, Sullivan H. Joint commissioning in health and social care: an exploration of processes, services and outcomes. Final report. NIHR Service Delivery and Organisation programme; 2012.
28.
Erens B, Wistow G, Mounier-Jack S, Douglas N, Jones L, Manacorda T and Mays N. Early evaluation of the integrated care and support pioneers programme: interim report. Policy Innovation Research Unit. 2015.
29.
Waring J, Marshall F, Bishop S. Understanding the occupational and organizational boundaries to safe hospital discharge. Journal of Health Services Research and Policy. 2015;20(suppl.1):35–44.CrossRef
30.
Weick KE. Sensemaking in organizations. Thousand Oaks: Sage Publications; 1995.
31.
Checkland K, Coleman A, Harrison S, Hiroeh U. ‘We can’t get anything done because...’: Making sense of ‘barriers’ to practice-based commissioning. J Health Services Res Pol. 2009;14(1):20–6.CrossRef
32.
Scott WR. Institutions and organizations, ideas and interests. Thousand Oaks: Sage Publications; 2008.
33.
Curry N, Harris M, Gunn L, Pappas Y, Blunt I, Soljak M, Mastellos N, Holder H, Smith JA, Majeed A, Ignatowicz A, Greaves F, Belsi A, Costin-Davis N, Jones Nielsen J, Greenfield G, Cecil E, Patterson S, Car J, Bardsley M. Integrated care pilot in North West London: a mixed methods evaluation. Int J Integr Care. 2013;13.
34.
Westminster City Council, The Royal Borough of Kensington and Chelsea, London Borough of Hammersmith & Fulham (2012). The tri-government community budget: rewarding ambition, fostering enterprise [online] London: The Royal Borough of Kensington and Chelsea. Available at: https://​www.​rbkc.​gov.​uk/​. Accessed 14 Sept 2018.
35.
36.
37.
38.
39.
Imperial College Health Partners and North West London Collaboration of Clinical Commissioning Groups. Brief for an evaluation of whole systems integrated care. London: Imperial College Health Partners; 2013.
40.
Lamont T, Barber N, De Pury J, et al. New approaches to evaluating complex health and care systems. Br Med J. 2016;352:i154.CrossRef
41.
42.
Yin RK. Case study research: design and methods (5th Ed.). London: Sage; 2014.
43.
44.
45.
Rosen R, Kumpunen S, Curry N, et al. Is bigger better? Lessons for large-scale general practice. London: the Nuffield Trust; 2016.
46.
Pettigrew L, Mays N, Kumpunen S, Rosen R. Large-scale general practice in England: what can we learn from the literature? London: the Nuffield Trust and London School of Hygiene and Tropical Medicine; 2016.
47.
Dixon-Woods M, McNicol S and Martin G (2012) Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Quality and Safety pp.bmjqs-2011.
48.
Casalino L. GP commissioning in the NHS in England: Ten suggestions from the United States. London: the Nuffield trust; 2011.
49.
Marmor T. Fads in medical care management and policy. London: the Nuffield Trust; 2004.
50.
Bardsley M, Steventon A, Smith JA, Dixon J. Evaluating community-based and integrated care: how do we know what works? London: Nuffield Trust; 2013.
51.
Bohmer RM. The hard work of health care transformation. N Engl J Med. 2016;375:709–11.CrossRef
52.
Oxford Brookes University. Institute of Public Care (2008). Commissioning for health and social care - commissioning cycle. London: SAGE.
53.
Deming, W.E. (1950) Elementary principles of the statistical control of quality. JUSE. Deming.
54.
Murray JG. Towards a common understanding of the differences between purchasing, procurement and commissioning in the UK public sector. J Purch Supply Manag. 2009;15:198–202.CrossRef
55.
NHS England. Delivering the five year forward view. Policy paper. London: NHS England; 2015.
56.
McLellan M, McKethan A, Lewis J, Roski J and Fisher E (2010) A national strategy to put accountable care into practice. Health Aff 29, no.5 pp982–990.
57.
Knapp M and Wistow G (1992) Joint commissioning for community care: paper presented to Department of Health Conference on commissioning, 10th July 1992, in J. Vaughan Smith (ed), Joint Commissioning for Community Care: A Slice Through Time, Department of Health/social services inspectorate/NHS management executive, 1993.
Metadata
Title
Evaluating the design and implementation of the whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link
Authors
Judith Smith
Gerald Wistow
Holly Holder
Matthew Gaskins
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4013-5

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