World class commissioning has already had a significant impact on primary care trusts and their development.

The 11 competencies (and the aspiration for year-on-year improvement) with local targets and a focus on governance will be a key driver for the implementation and delivery of Lord Darzi's next stage review.

Hospital clinicians need to be aware that there will be significant changes that will affect their services. Commissioners are aspiring to develop competencies that will have an impact on patient pathways, quality, clinical performance and innovation.

For example, PCTs will be required to ensure:

  • that there is active clinical leadership across the PCT agenda;

  • that the PCT and providers review and agree on clinical pathways and work towards improvement and innovation;

  • that contract agreements support collection of performance data (including poor performance) where national data is not available, and ownership and management control of data is clearly defined.

Hospital doctors and their clinical teams have previously not had much contact with commissioners and have had little knowledge of what they do or their agenda.

Developing new skills

But this is changing. Hospital clinicians will increasingly be asked to meet with commissioners, who will challenge current pathways for patient care. "Why does the patient need to be seen before they have a scan? Why do these patients need any follow-up? Why can't we have a one-stop clinic?"

More importantly, PCTs will want to ensure there are robust data systems to collect evidence of patient satisfaction and quality of outcomes. This data should also be available to providers for internal governance reporting, to consultants and their teams for revalidation, and to patients when they choose which hospital to go to for their care. In other words, it should be in the public domain.

Hospital clinicians need to recognise that the commissioning world has changed. Most have little knowledge of innovation, redesign or commissioning; most have never seen a statistical process control chart; and few have evidence of patient satisfaction. They must master the skills they need to be able to sit down and meaningfully discuss the future development of their services with commissioners.

Provider trusts need to work with and support the development of their clinical teams to give them some of the competencies commissioners are currently developing. This work needs to start now, otherwise in 2009-10 we will see providers and their clinical teams having some difficult conversations with world class commissioners.