The evolution of NHS commissioning: evidence to support changes to local planning functions

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Why we're doing this project

NHS commissioning is changing. Growing numbers of clinical commissioning groups (CCGs) are working together or formally merging, and some are arranging services jointly with local authorities; sustainability and transformation partnerships are bringing together providers and commissioners to plan services; and, in some places, integrated care systems are going further: developing new approaches which may see providers take on responsibility for much of the day-to-day work of commissioning. While commissioners and providers remain separated in law, the line between the two is becoming increasingly blurred in practice.

These changes mean that the responsibility for conducting commissioning ‘tasks’ or ‘functions’ – ie, the activities needed to plan health care like setting priorities, procuring services and monitoring performance – will shift between organisations, and in some cases fall to providers. Most of these functions (which are often described as a ‘commissioning cycle’) will continue, whatever changes are implemented to local structures.

This project seeks to support systems as their commissioning structures evolve by presenting evidence to inform decision-making. 

What we're doing

We will look at what works for the key tasks of commissioning, and explore new emerging models by analysing: 

  • learning from previous and the current models of commissioning in England 
  • how other advanced health systems plan services, including those which do not have a recognised commissioning function, eg, Scotland
  • how innovative systems in England are changing the way they commission services, and why they made those choices.

To do this, we will review published literature and work with a small number of case study areas to understand their emerging approaches.

How can you get involved?

We are looking for case studies and are keen to hear from areas of England that are evolving their approach to commissioning, which includes changes to any of the following functions: 

  • strategic planning 
  • service development 
  • monitoring and evaluation
  • involving the public or health professionals.

If you are working in a system which is making changes in one or several of these areas, please email Leo Ewbank. We’d like to hear about the changes being made, including who is performing the commissioning functions and how. 

Key milestones

A final report will be published in late 2019.

Project team


Ruth Robertson

Senior Fellow, Policy


Leo Ewbank

Researcher, Policy