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Driving forward system working: A snapshot of early progress in collaborative commissioning

The forthcoming NHS long-term plan is expected to champion collaboration between health and care organisations in local systems as the key mechanism for driving improvement and sustainability. As sustainability and transformation partnerships (STPs) develop and more integrated care systems (ICSs) emerge, the commissioning landscape is evolving to meet the needs of local populations within the new world of system working. In Steering towards strategic commissioning, NHS Clinical Commissioners (NHSCC) highlighted the fact that this evolution is happening at pace and set out the future direction for clinical commissioning groups (CCGs) as strategic commissioners (NHS Clinical Commissioners, 2017). It is now timely to revisit the commissioning landscape and explore how providers, too, are adapting their ways of working.

This report, commissioned by both NHSCC and NHS Providers, therefore explores emerging practice in systems that are rethinking the way in which they plan and design services at a local level to support the delivery of joined-up and sustainable care. It revisits views from leaders in CCGs, providers, national bodies and think tanks about the concept of strategic commissioning, particularly as CCGs are increasingly working together to focus on outcomes across larger geographies and reduce management costs. It also explores views about the likelihood that providers will take on more of the activities that NHS England (as a direct commissioner) or CCGs currently undertake – be that to help develop service specifications or lead on pathway redesign.

It is important to be clear that the statutory commissioning functions of CCGs as detailed in the 2012 Health and Social Care Act remain, even if the way in which those functions and associated tasks are transacted is evolving .This may be through clinical commissioners operating at system level, working with providers at place level, or even delegating delivery of those functions to their providers via a range of contractual mechanisms.

This report sets out a shared ambition for clinical commissioners and providers to collaborate as system partners. To help our respective members – CCGs and NHS trusts and foundation trusts – work towards this ambition, we identify a number of barriers and enablers to the development of integrated, collaborative working. While these developments are very much a work in progress, we hope this report provides a useful snapshot of practice at the frontline and working examples for systems to use.