The use of external support is now standard practice in NHS commissioning organisations. Commissioners use support in a range of forms, from short-term consultancy to longer-term partnerships and outsourcing.
Around one half (52 per cent) of NHS managers surveyed believed that external support will be required to develop high-quality commissioning in the NHS, with 28 per cent disagreeing. Most also believed that, with or without support, this will take several years to achieve. A large majority (86 per cent) said it would take at least three or four years, and a quarter (26 per cent) said it would take five to ten years.
Levels of satisfaction among those who have used external support are reasonably high. Our case studies identified examples where external support had succeeded in improving commissioning processes. External organisations seem particularly well placed to provide support with the analysis and application of data, and with commercial skills.
However, it is also clear that external support is not always used effectively. Commissioners do not always use support in a way that takes full advantage of the skills existing in external organisations. They sometimes struggle to identify their needs and procure appropriate support to address them. Poor working relationships between internal and external teams can also limit effectiveness. As a result, objectives are not always achieved.
There is some evidence that poorer performing PCTs, whose developmental needs are the greatest, may be in the weakest position to use and benefit from the services that external organisations offer – in part because of high levels of organisational instability and in part because of limited managerial capacity or capability to implement or act on the work produced by external consultants.
Cost-effectiveness will be the key issue for external support over the coming years, as the NHS comes under increasing pressure to justify management expenses. Commissioners remain to be convinced that external support always offers an acceptable return on investment.
The role and nature of external support will evolve over time. The coalition government’s intention to transfer most commissioning responsibilities from PCTs to GP consortia may present opportunities for external organisations to be increasingly involved in supporting commissioning at this level.
Our overall assessment is that, if used appropriately, external support can play a role in raising the standard of commissioning in the NHS, and in doing so help the system to achieve the improvements in quality and productivity needed over the coming years.
The report includes recommendation for commissioners on how to use external support in the most cost-effective way. There are also recommendations for policy makers and for suppliers of external support.
