The role of clinical commissioning in public health

Numerous discussions are taking place on the possible benefits and problems associated with future commissioning arrangements in the form of GP consortia.

These represent a new opportunity to improve the health of their local people. A huge amount of work has to be done to help people improve their lifestyle and take charge of their personal health and well-being.

There is therefore a strong argument in favour of commissioning being processed as near to the public as possible. The NHS structure closest to the public is general practice, which has survived and flourished during both hard and relatively easy times. However, high-quality commissioning cannot be achieved by GPs alone.

Without achieving successful engagement between the new consortia and nurses and doctors working within the consortia boundaries, commissioning may fail to deliver on value for money.

Engaging with clinicians working in the community and general practice is particularly challenging given the fragmentation and nature of the service. However, GPs and community nurses are knowledgeable about the way families live and the barriers that exist when adapting lifestyles from being health harming to health promoting. Such deep understanding of the people who need the most support is critical to wise spending.

Commissioning must constantly be informed through genuine engagement with the doctors, nurses and therapists whose main component of their work is direct and personal contact with the public.

It is essential for a significant number of nurses, along with former primary care trust commissioning staff, to take their place within the new consortia.

Positioning nurse leaders within the consortia would ensure that commissioning takes account of the quality, innovation, productivity and prevention programme, nursing metrics, patient-reported outcomes, quality indicators and other patient-sensitive data.

The Royal College of Nursing has identified reasons why nurses are indispensable to commissioning. They:

• ensure commissioning reaches far beyond medicine and management and into health improvement and care quality;
• are well placed to integrate the knowledge held by frontline community nurses, health visitors and midwives with that held by departments of public health. Commissioning plans must relate to people’s lives and the aspirations they have for themselves and their families. There are many cost-neutral changes to services which can improve uptake, such as amending the time of baby clinics and providing transport to leg ulcer clinics;
• are key to unlocking resources from traditional patterns of service and investing them in new multi-agency partnerships;
• help ensure local knowledge developed through long-term relationships between community nurses and local people is not diminished by commercial sensitivities and short-term contractual cycles;
• engage with their hospital based specialist nurse colleagues when services need to be reviewed and redesigned, according to local strategies;
• have expertise in budget management and understand the resource implications of the decisions made by board members. They are also able to inform fellow commissioners of the potential impact on patient care and outcomes of service redesign or decommissioning;
• review research and scan horizons to determine how services are provided nationally, internationally and from independent healthcare sectors;
• are experienced in managing healthcare systems and can identify which clinicians to engage with;
• are able to lead in developing improved integration between health and social care services;
• can identify faults and weaknesses and work with colleagues to achieve transformational change;
• have a long history of working across organisational boundaries and operate within networks which encourage clinicians to challenge outdated ways of working in order for best practice to be implemented.