Commissioning happens at many levels in the health and wellbeing system. There is not a single ‘ideal’ level for commissioning all services; there is a continuum of commissioning activity that runs across the health and wellbeing system. See What is commissioning in the North West? for a fuller discussion of commissioning levels and their definition.

This section of the website will explore the different levels of commissioning, including self-directed support, practice-based commissioning and, specifically, strategic commissioning. It will look at guidance, tools and case studies that could help strategic commissioners develop their commissioning processes, as well as signposting to other materials.

The Institute of Public Care’s joint commissioning model for public care can be adapted to illustrate the links between emerging activities and levels of commissioning for health and wellbeing services. At any level, commissioning can be thought of as a series of activities that can be grouped under the four key performance management elements of analyse, plan, do and review - which are sequential and of equal importance, i.e. commissioners should spend equal time, energy and attention on all four elements.

Emerging activities and levels in the commissioning cycle

Source: Adapted from Institute of Public Care

Shown at the centre of the diagram, self-directed support via direct payments and individual budgets is a way of redesigning the social care system so that the people who get services can take much greater control over them. It is the government’s intention that service users and carers themselves should increasingly assume the lead role in commissioning services to meet their own individual needs and aspirations. To fully adopt this approach will require fundamental changes to the present system of assessment and care management and will impact on the strategic commissioning role.

It is hoped that practice-based commissioning will give practices an incentive to develop more local services, which will provide better value for money and have more of a focus on prevention. PCTs will still remain responsible for the use of health funds and for the agreement of contracts, but GPs will have more responsibility for local health budgets. As more commissioning decisions are be made at practice, not PCT, level, joint commissioning arrangements and links with localities may need to be reassessed.

Traditionally, strategic commissioning by PCTs and local authorities determined how to make the best use of available resources on the basis of population needs assessments and evaluating existing services and notable practice elsewhere. However, the role of strategic commissioning will need to change as control of resources moves closer to patients and service users. There will still be a need for strategic commissioning, but increasingly it will be to develop the market for the whole community, not just for those whose care they fund, by leading and coordinating the activities of different agencies.