What is co-commissioning?
CCGs were invited to express a level of interest in co-commissioning. 196 of England’s 211 Clinical Commissioning Groups have submitted bids, according to NHS England July Board Papers.
Since Simon Sevens took up post as Chief Executive of NHS England, ‘co-commissioning’ has firmly established itself as flavour of the month. But what exactly does it mean?
The first thing to say is that it is not a term that has been widely used before, and where it has it has generally focussed on the relationship between commissioners and the public. Governance International describes it as "the public sector and citizens working together, using each other's knowledge and expertise, to prioritise which services should be provided for which people, using public resources and the resources of communities."
Elsewhere, for example in the prison service, it means different commissioning bodies aligning strategies whilst retaining direct responsibility for resources. What is clear is that there is no single definition.
This ambiguity is causing confusion. Co-commissioning of primary care in recent months has been talked and written about widely, with different people understanding different things by it.
For example, many GPs and Local Management Committees (LMCs) understand co-commissioning to mean CCGs taking on the contracting of general practice. Others understand it to be NHS England and CCGs working together to align strategies.
This confusion is not limited to different understandings by different stakeholders, for example with LMCs thinking one thing, and CCGs thinking another. Different CCGs understand the term to mean different things. Some CCGs, in discussing the question ‘shall we take on co-commissioning?’, actually discussed the question ‘shall we take on the contracting of general practice?’. Others discussed the question, ‘shall we work on a joint partnership with the Area Team?’.
Inevitably the question that was discussed by the CCG framed the response, and the general level of enthusiasm shown. Many discussing the contracting question were understandably reticent, given the huge tension that membership organisations, contracting with their members, can create.
Other CCGs, discussing the partnership-working question where relationships are strong, were of the view that this was already happening and saw no need to express an interest. This does not mean they don’t want to co-commission, it means they don’t want to be distracted by yet another bureaucratic process.
Much is being made of the ‘levels’ of co-commissioning that CCGs have applied for. CCGs could apply for one of three levels: the first level is ‘greater involvement’; the second level is ‘jointly commission’; and the third level is ‘delegate commissioning arrangements to CCGs’.
According to NHS England, 74 CCGs have applied for the third level. The reality is I have spoken to a number of CCGs who have applied for the third level who meant exactly the same as those who applied for the first level.
There are a minority of CCGs who, in the absence of a better alternative, want to take on the contracting of primary care and of general practice in particular. The majority do not want to do this, but they do want to work with their local Area Team to ensure that the key role that primary care plays in all CCGs’ five year plans is delivered.
As Simon Stevens now starts to talk about co-commissioning of specialist services, clarity of what is meant by ‘co-commissioning’ is increasingly important. I believe that what was first meant by the term 'delegated budgets' has iterated to something different - partnership working - which is much more helpful. No-one is in any doubt that the existing arrangements are not effective, so it is critical that NHS England and CCGs do find a way of working together going forward. Whether or not we call this ‘co-commissioning’ is, frankly, immaterial.
Ben Gowland is the Chief Executive at NHS Nene CCG and formerly Director, Service Improvement and Quality, Croydon Health Services NHS Trust.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.
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