This paper was originally published in March 2011. It was last updated in June 2015 to reflect changes in the NHS.
Health care commissioners will need to deliver a sustainable system in the face of the most challenging financial and organisational environment seen in decades.
They must shift the current emphasis on acute and episodic care towards prevention, self-care and integrated and well co-ordinated care to cope with an aging population and increased prevalence of chronic diseases. And they will need to direct resources to the patients with greatest need and redress the 'inverse care law' by which those who need the most care often receive the least.
The new NHS from 1 April 2013
The organisations commissioning health services in England changed radically in April 2013. Clinical commissioning groups (CCGs) are now responsible for the majority of the NHS budget, controlling around £69 billion in 2015/16. Public health budgets of £2.8 billion have transferred to local authorities (although this figure does not take into account the in-year budget cuts to the public health grant of £200 million announced in June 2015, or the funding that will flow to local authorities due to the transfer of significant NHS responsibilities from October 2015). NHS England is responsible for commissioning primary care (£12 billion) and specialised services (£15 billion), largely through its 4 regional teams and the sub-regions that sit beneath them.
As of April 2015, in most parts of the country NHS England shares these responsibilities with CCGs through co-commissioning arrangements, although the extent of delegation varies between CCGs.