Journal of Public Health Medicine 21:221-227 (1999)
© 1999 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
Models of commissioning health services in the British National Health Service: a literature review
D Chappel0,z
P Miller1
D Parkin0
R Thomson0
0 Department of Epidemiology and Public Health, School of Health Sciences, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK
1 Trent Institute for Health Services Research, University of Nottingham, Nottingham NG7 2RD, UK
z Corresponding author
The commissioning of health services is an under-researched area and yet it is critical to the way services meet health needs and to the quality of care. Recent emphasis in the United Kingdom and elsewhere has been on a 'primary care led National Health Service', particularly on locality commissioning through primary care groups. However, there are other models of commissioning using 'programmes of care' (focused on diseases or patient groups rather than geography) which may offer greater benefits. There is little research comparing the benefits and costs of these models, and most are not even clearly enough described to be replicated. There will always be a political dimension to models of commissioning, dependent, for example, on the balance of power in the decision-making process. None the less, a broader knowledge of possible models and a willingness to evaluate rigorously are needed if commissioning of health services is to result in better patient care.
Keywords: health planning, health policy, health care reform, health services administration