A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy
Karen Gardner A , G. Powell Davies A , Karen Edwards A , Julie McDonald A , Terry Findlay A , Rachael Kearns A , Chandni Joshi A and Mark Harris A B
+ Author Affiliations
- Author Affiliations
A Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
B Corresponding author. Email: m.f.harris@unsw.edu.au
Australian Journal of Primary Health 22(1) 40-49 https://doi.org/10.1071/PY15148
Submitted: 13 October 2015 Accepted: 4 December 2015 Published: 29 February 2016
Journal Compilation © La Trobe University 2016
Abstract
The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning.
Additional keywords: contracting, planning, primary health care, purchasing.
References
Ashman I, Willcocks S (2014) Engaging with clinical commissioning: the attitudes of general practitioners in East Lancashire. Quality in Primary Care 22, 91–99.Ashton T, Cumming J, McLean J (2004) Contracting for health services in a public health system: the New Zealand experience. Health Policy (Amsterdam) 69, 21–31.
| Contracting for health services in a public health system: the New Zealand experience.Crossref | GoogleScholarGoogle Scholar |
Ashton T, Tenbensel T, Cumming J, Barnett P (2008) Decentralizing resource allocation: early experiences with District Health Boards in New Zealand. Journal of Health Services Research & Policy 13, 109–115.
| Decentralizing resource allocation: early experiences with District Health Boards in New Zealand.Crossref | GoogleScholarGoogle Scholar |
Australian Government (2015) Reform of the Federation: discussion paper. Australian Government, Canberra.
Barnes K, Longfield P, Jones K, Littlemore G, McDonough C, McIntyre A, McLaughlin M (2013) Evidence based commissioning: calculating shift potentials for paediatric services. Clinical Governance 18, 39–48.
| Evidence based commissioning: calculating shift potentials for paediatric services.Crossref | GoogleScholarGoogle Scholar |
Baxter K, Weiss M, Le Grand J (2007) Collaborative commissioning of secondary care services by primary care Trusts. Public Money & Management 27, 207–214.
| Collaborative commissioning of secondary care services by primary care Trusts.Crossref | GoogleScholarGoogle Scholar |
Bovaird T, Dickinson H, Allen K (2012) Commissioning across government: review of evidence. Third Sector Research Centre research report (86). Available at http://www.birmingham.ac.uk/generic/tsrc/documents/tsrc/reports/research-report-86-commissioning-across-govt.pdf [Accessed 11 January 2016]
Bradley F, Elvey R, Ashcroft D, Noyce P (2006) Commissioning services and the new community pharmacy contract: (2) drivers, barriers and approaches to commissioning. The Pharmaceutical Journal 277, 189–192.
Bravo Vergel Y, Ferguson B (2006) Difficult commissioning choices: lessons from English primary care trusts. Journal of Health Services Research & Policy 11, 150–154.
| Difficult commissioning choices: lessons from English primary care trusts.Crossref | GoogleScholarGoogle Scholar |
Checkland K, Coleman A, Harrison S, Hiroeh U (2009) ‘We can’t get anything done because…’: making sense of ‘barriers’ to Practice-based Commissioning. Journal of Health Services Research & Policy 14, 20–26.
| ‘We can’t get anything done because…’: making sense of ‘barriers’ to Practice-based Commissioning.Crossref | GoogleScholarGoogle Scholar |
Checkland K, Snow S, McDermott I, Harrison S, Coleman A (2012) ‘Animateurs’ and animation: what makes a good commissioning manager? Journal of Health Services Research & Policy 17, 11–17.
| ‘Animateurs’ and animation: what makes a good commissioning manager?Crossref | GoogleScholarGoogle Scholar |
Checkland K, Coleman A, McDermott I, Segar J, Miller R, Petsoulas C, Wallace A, Harrison S, Peckham S (2013) Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England. The British Journal of General Practice 63, e611–e619.
| Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England.Crossref | GoogleScholarGoogle Scholar | 23998841PubMed |
Coleman A, Checkland K, McDermott I, Harrison S (2013) The limits of market-based reforms in the NHS: the case of alternative providers in primary care. BMC Health Services Research 13, S3
| The limits of market-based reforms in the NHS: the case of alternative providers in primary care.Crossref | GoogleScholarGoogle Scholar | 23735051PubMed |
Dickinson H (2015) Commissioning public services evidence review: evidence for Australian public services. Melbourne School of Government, University of Melbourne.
Dickinson H, Glasby J, Nicholds A, Sullivan H (2013) Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency. BMC Health Services Research 13, S6
| Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency.Crossref | GoogleScholarGoogle Scholar | 23734566PubMed |
Dusheiko M, Gravelle H, Jacobs R, Smith P (2006) The effect of financial incentives on gatekeeping doctors: evidence from a natural experiment. Journal of Health Economics 25, 449–478.
| The effect of financial incentives on gatekeeping doctors: evidence from a natural experiment.Crossref | GoogleScholarGoogle Scholar | 16188338PubMed |
Elvey R, Bradley F, Ashcroft D, Noyce P (2006) Commissioning services and the new community pharmacy contract: (1) [harmaceutical needs assessments and uptake of new contracts]. The Pharmaceutical Journal 277, 161–163.
Figueras J, Robinson R, Jakubowski E (2005) ‘Purchasing to improve health systems performance.’ (Open University Press: Madenhead, UK.)
Freeman T, Peck E (2006) Evaluating partnerships: a case study of integrated specialist mental health services. Health & Social Care in the Community 14, 408–417.
| Evaluating partnerships: a case study of integrated specialist mental health services.Crossref | GoogleScholarGoogle Scholar |
Goldman C (2010) Joint financing across health and social care: money matters but outcomes matter more. Journal of Integrated Care 18, 3–10.
| Joint financing across health and social care: money matters but outcomes matter more.Crossref | GoogleScholarGoogle Scholar |
Gridley K, Spiers G, Aspinal F, Bernard S, Atkin K, Parker G (2012) Can general practitioner commissioning deliver equity and excellence? Evidence from two studies of service improvement in the English NHS. Journal of Health Services Research & Policy 17, 87–93.
| Can general practitioner commissioning deliver equity and excellence? Evidence from two studies of service improvement in the English NHS.Crossref | GoogleScholarGoogle Scholar |
Guterman S, Zezza MA, Schoen C (2013) Paying for value: replacing Medicare’s sustainable growth rate formula with incentives to improve care. Issue Brief (Commonwealth Fund) 16, 1–10.
Ham C (2008) World class commissioning: a health policy chimera? Journal of Health Services Research & Policy 13, 116–121.
| World class commissioning: a health policy chimera?Crossref | GoogleScholarGoogle Scholar |
Hussey P, Ridgely S, Rosenthal M (2011) The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models. Health Affairs 30, 2116–2124.
| The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models.Crossref | GoogleScholarGoogle Scholar | 22068404PubMed |
Joyce C (2015) Person-centred services? Rhetoric versus reality Australian Journal of Primary Health
| Person-centred services? Rhetoric versus realityCrossref | GoogleScholarGoogle Scholar | 26349619PubMed |
Kennington E, Shepherd E, Evans D, Duggan C (2013) Benefits of healthy living pharmacies for commissioner and contractor/employer. International Journal of Pharmacy Practice 21, 122
King A (2001) The Primary Health Care Strategy. The New Zealand Ministry of Health. Wellington, New Zealand. Available at http://www.health.govt.nz/system/files/documents/publications/phcstrat.pdf [Verified February 2016]
Ly DP, Glied SA (2014) The impact of managed care contracting on physicians. Journal of General Internal Medicine 29, 237–242.
| The impact of managed care contracting on physicians.Crossref | GoogleScholarGoogle Scholar | 24002628PubMed |
Mannion R (2008) General practitioner commissioning in the English national health service: continuity, change and future challenges. International Journal of Health Services 38, 717–730.
| General practitioner commissioning in the English national health service: continuity, change and future challenges.Crossref | GoogleScholarGoogle Scholar | 19069289PubMed |
Marks L, Cave S, Hunter D, Mason J, Peckham S, Wallace A (2011) Governance for health and wellbeing in the English NHS. Journal of Health Services & Research Policy 16, 14–21.
| Governance for health and wellbeing in the English NHS.Crossref | GoogleScholarGoogle Scholar |
McCafferty S, Williams I, Hunter D, Robinson S, Donaldson C, Bate A (2012) Implementing world class commissioning competencies. Journal of Health Services Research & Policy 17, 40–48.
| Implementing world class commissioning competencies.Crossref | GoogleScholarGoogle Scholar |
McLeod H, Blissett D, Wyatt S, Mohammed MA (2015) Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: a cluster controlled study. PLoS One 10, e0123349
| Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: a cluster controlled study.Crossref | GoogleScholarGoogle Scholar | 25875959PubMed |
National Collaborating Centre for Methods and Tools (2014) Methods: synthesis 1. Rapid reviews: methods and implications [fact sheet]. Available at http://www.nccmt.ca/pubs/Methods_Synthesis1.pdf [Verified 11 January 2016]
Naylor C, Goodwin N (2011) The use of external consultants by NHS commissioners in England: what lessons can be drawn for GP commissioning? Journal of Health Services Research & Policy 16, 153–160.
| The use of external consultants by NHS commissioners in England: what lessons can be drawn for GP commissioning?Crossref | GoogleScholarGoogle Scholar |
Newman M, Bangpan M, Kalra N, Mays N, Kwan I, Roberts T (2012) Commissioning in health, education and social care: models, research bibliography and in-depth review of joint commissioning between health and social care agencies. Available at http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=3356 [Verified 1 January 2016]
Newton JT, Alexandrou B, Bate BD, Best H (2006) A qualitative analysis of the planning, implementation and management of a PDS scheme: Lessons for local commissioning of dental services. British Dental Journal 200, 625–630.
| A qualitative analysis of the planning, implementation and management of a PDS scheme: Lessons for local commissioning of dental services.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28zltFahtQ%3D%3D&md5=d393554ecad3397b71463c5700dc9648CAS | 16767141PubMed |
O’Brien S (2013) SA Health Clinical Commissioning Intentions July 2013–June 2017. South Australian Department for Health and Ageing, Adelaide. Available at https://www.sahealth.sa.gov.au/wps/wcm/connect/e32a3e8040b4d859a817fb809397f885/Clinical+Commissioning+Intentions-Plan%26Comm-Pol%26Comm-20130812.pdf?MOD=AJPERES&CACHEID=e32a3e8040b4d859a817fb809397f885 [Verified February 2016]
Perkins N, Coleman A, Wright M, Gadsby E, McDermott I, Petsoulas C, Checkland K (2014) The ‘added value’ GPs bring to commissioning: a qualitative study in primary care. The British Journal of General Practice 64, e728–e734.
Petsoulas C, Allen P, Checkland K, Coleman A, Segar J, Peckham S, Mcdermott I (2014) Views of NHS commissioners on commissioning support provision: evidence from a qualitative study examining the early development of clinical commissioning groups in England. BMJ Open 4, e005970
| Views of NHS commissioners on commissioning support provision: evidence from a qualitative study examining the early development of clinical commissioning groups in England.Crossref | GoogleScholarGoogle Scholar | 25320000PubMed |
Primary Health Care Advisory Group (2015) Better outcomes for people with chronic and complex health conditions through primary health care. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/2D8BCF439DE725CACA257E93001B462A/$File/discussion.pdf [Verified 1 January 2016]
Robinson JC (2004) Reinvention of health insurance in the consumer era. Journal of the American Medical Association 291, 1880–1886.
| Reinvention of health insurance in the consumer era.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXjsVajsbk%3D&md5=9307f5068fd72ef2cda4397851fb3e0aCAS | 15100208PubMed |
Robinson S, Williams I, Dickinson H, Freeman T, Rumbold B (2012a) Priority-setting and rationing in healthcare: evidence from the English experience. Social Science & Medicine 75, 2386–2393.
| Priority-setting and rationing in healthcare: evidence from the English experience.Crossref | GoogleScholarGoogle Scholar |
Robinson S, Williams I, Freeman T, Rumbold B, Williams I (2012b) Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England. Health Services Management Research 5, 113–120.
| Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England.Crossref | GoogleScholarGoogle Scholar |
Rooshenas L, Owen-Smith A, Donovan J, Hollingworth W (2013) Saving money in the NHS: a qualitative investigation of disinvestment practices, and barriers to change. Lancet 382, S18
| Saving money in the NHS: a qualitative investigation of disinvestment practices, and barriers to change.Crossref | GoogleScholarGoogle Scholar |
Russell J, Greenhalgh T, Lewis H, MacKenzie I, Maskrey N, Montgomery J, O’Donnell C (2013) Addressing the ‘postcode lottery’ in local resource allocation decisions: a framework for clinical commissioning groups. Journal of the Royal Society of Medicine 106, 120–123.
| Addressing the ‘postcode lottery’ in local resource allocation decisions: a framework for clinical commissioning groups.Crossref | GoogleScholarGoogle Scholar | 23564895PubMed |
Salmon R, Sanderson M, Walters B, Kennedy K, Flores R, Muney A (2012) A collaborative accountable care model in three practices showed promising results on costs and quality of care. Health Affairs 31, 2379–2387.
| A collaborative accountable care model in three practices showed promising results on costs and quality of care.Crossref | GoogleScholarGoogle Scholar | 23129667PubMed |
Sampson F, O’Cathain A, Strong M, Pickin M, Esmonde L (2012) Commissioning processes in primary care trusts: a repeated cross-sectional survey of health care commissioners in England. Journal of Health Services Research & Policy 17, 31–39.
| Commissioning processes in primary care trusts: a repeated cross-sectional survey of health care commissioners in England.Crossref | GoogleScholarGoogle Scholar |
Shaw SE, Smith JA, Porter A, Rosen R, Mays N (2013) The work of commissioning: a multisite case study of healthcare commissioning in England’s NHS. BMJ Open 3, e003341
| The work of commissioning: a multisite case study of healthcare commissioning in England’s NHS.Crossref | GoogleScholarGoogle Scholar | 24014483PubMed |
Sheaff R, Chambers N, Charles N, Exworthy M, Mahon A, Byng R, Mannion R (2013) How managed a market? Modes of commissioning in England and Germany. BMC Health Services Research 13, S8
| How managed a market? Modes of commissioning in England and Germany.Crossref | GoogleScholarGoogle Scholar | 23734631PubMed |
Slater B, White J (2007) Practice-based commissioning: learning from a development programme. Journal of Integrated Care 15, 13–25.
| Practice-based commissioning: learning from a development programme.Crossref | GoogleScholarGoogle Scholar |
Song Z (2014) Accountable care organizations in the U.S. health care system. Journal of Clinical Outcomes Management 21, 364–371.
Turner D, Salway S, Mir G, Ellison GT, Skinner J, Carter L, Bostan B (2013) Prospects for progress on health inequalities in England in the post-primary care trust era: professional views on challenges, risks and opportunities. BMC Public Health 13, 274
| Prospects for progress on health inequalities in England in the post-primary care trust era: professional views on challenges, risks and opportunities.Crossref | GoogleScholarGoogle Scholar | 23530661PubMed |
Tynkkynen LK, Lehto J, Miettinen S (2012) Framing the decision to contract out elderly care and primary health care services – perspectives of local level politicians and civil servants in Finland. BMC Health Services Research 12, 201
| Framing the decision to contract out elderly care and primary health care services – perspectives of local level politicians and civil servants in Finland.Crossref | GoogleScholarGoogle Scholar | 22805167PubMed |
Wilson E, Sussex J, Macleod C, Fordham R (2007) Prioritizing health technologies in a Primary Care Trust. Journal of Health Services Research & Policy 12, 80–85.
| Prioritizing health technologies in a Primary Care Trust.Crossref | GoogleScholarGoogle Scholar |
