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Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market

Alison Porter Orcid Logo, Nicholas Mays, Sara E Shaw, Rebecca Rosen, Judith Smith

BMC Health Services Research, Volume: 13, Issue: S1

Swansea University Author: Alison Porter Orcid Logo

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DOI (Published version): 10.1186/1472-6963-13-s1-s2

Abstract

BackgroundSince 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS pati...

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Published in: BMC Health Services Research
ISSN: 1472-6963
Published: Springer Science and Business Media LLC 2013
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URI: https://cronfa.swan.ac.uk/Record/cronfa54274
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2022-11-11T15:36:24.2258580</datestamp><bib-version>v2</bib-version><id>54274</id><entry>2013-05-24</entry><title>Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England&#x2019;s NHS quasi-market</title><swanseaauthors><author><sid>fcc861ec479a79f7fb9befb13192238b</sid><ORCID>0000-0002-3408-7007</ORCID><firstname>Alison</firstname><surname>Porter</surname><name>Alison Porter</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2013-05-24</date><deptcode>HDAT</deptcode><abstract>BackgroundSince 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS patients. We examine the extent to which local commissioners had adopted a market-oriented (transactional) model of commissioning of care for people with long term conditions several years into the latest period of market-oriented reform. The paper also considers the factors that may have inhibited or supported market-oriented behaviour, including the presence of conditions conducive to a health care quasi-market.MethodsWe studied the commissioning of services for people with three long term conditions - diabetes, stroke and dementia - in three English primary care trust (PCT) areas over two years (2010-12). We took a broadly ethnographic approach to understanding the day-to-day practice of commissioning. Data were collected through interviews, observation of meetings and from documents.ResultsIn contrast to a transactional, market-related approach organised around commissioner choice of provider and associated contracting, commissioning was largely relational, based on trust and collaboration with incumbent providers. There was limited sign of commissioners significantly challenging providers, changing providers, or decommissioning services.In none of the service areas were all the conditions for a well functioning quasi-market in health care in place. Choice of provider was generally absent or limited; information on demand and resource requirements was highly imperfect; motivations were complex; and transaction costs uncertain, but likely to be high. It was difficult to divide care into neat units for contracting purposes. As a result, it is scarcely surprising that commissioning practice in relation to all six commissioning developments was dominated by a relational approach.ConclusionsOur findings challenge the notion of a strict separation of commissioners and providers, and instead demonstrate the adaptive persistence of relational commissioning based on continuity of provision, trust and interdependence between commissioners and providers, at least for services for people with long-term conditions.</abstract><type>Journal Article</type><journal>BMC Health Services Research</journal><volume>13</volume><journalNumber>S1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1472-6963</issnElectronic><keywords>National Health Service; Term Condition; Primary Care Trust; National Health Service Trust; Incumbent Provider</keywords><publishedDay>24</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2013</publishedYear><publishedDate>2013-05-24</publishedDate><doi>10.1186/1472-6963-13-s1-s2</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2022-11-11T15:36:24.2258580</lastEdited><Created>2013-05-24T00:00:00.0000000</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>1</order></author><author><firstname>Nicholas</firstname><surname>Mays</surname><order>2</order></author><author><firstname>Sara E</firstname><surname>Shaw</surname><order>3</order></author><author><firstname>Rebecca</firstname><surname>Rosen</surname><order>4</order></author><author><firstname>Judith</firstname><surname>Smith</surname><order>5</order></author></authors><documents><document><filename>54274__25743__2d6a92509a504d6194267eff2b582ae9.pdf</filename><originalFilename>54274.pdf</originalFilename><uploaded>2022-11-11T15:35:35.6583221</uploaded><type>Output</type><contentLength>323177</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2013 Porter et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/2.0</licence></document></documents><OutputDurs/></rfc1807>
spelling 2022-11-11T15:36:24.2258580 v2 54274 2013-05-24 Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false 2013-05-24 HDAT BackgroundSince 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS patients. We examine the extent to which local commissioners had adopted a market-oriented (transactional) model of commissioning of care for people with long term conditions several years into the latest period of market-oriented reform. The paper also considers the factors that may have inhibited or supported market-oriented behaviour, including the presence of conditions conducive to a health care quasi-market.MethodsWe studied the commissioning of services for people with three long term conditions - diabetes, stroke and dementia - in three English primary care trust (PCT) areas over two years (2010-12). We took a broadly ethnographic approach to understanding the day-to-day practice of commissioning. Data were collected through interviews, observation of meetings and from documents.ResultsIn contrast to a transactional, market-related approach organised around commissioner choice of provider and associated contracting, commissioning was largely relational, based on trust and collaboration with incumbent providers. There was limited sign of commissioners significantly challenging providers, changing providers, or decommissioning services.In none of the service areas were all the conditions for a well functioning quasi-market in health care in place. Choice of provider was generally absent or limited; information on demand and resource requirements was highly imperfect; motivations were complex; and transaction costs uncertain, but likely to be high. It was difficult to divide care into neat units for contracting purposes. As a result, it is scarcely surprising that commissioning practice in relation to all six commissioning developments was dominated by a relational approach.ConclusionsOur findings challenge the notion of a strict separation of commissioners and providers, and instead demonstrate the adaptive persistence of relational commissioning based on continuity of provision, trust and interdependence between commissioners and providers, at least for services for people with long-term conditions. Journal Article BMC Health Services Research 13 S1 Springer Science and Business Media LLC 1472-6963 National Health Service; Term Condition; Primary Care Trust; National Health Service Trust; Incumbent Provider 24 5 2013 2013-05-24 10.1186/1472-6963-13-s1-s2 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 2022-11-11T15:36:24.2258580 2013-05-24T00:00:00.0000000 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Alison Porter 0000-0002-3408-7007 1 Nicholas Mays 2 Sara E Shaw 3 Rebecca Rosen 4 Judith Smith 5 54274__25743__2d6a92509a504d6194267eff2b582ae9.pdf 54274.pdf 2022-11-11T15:35:35.6583221 Output 323177 application/pdf Version of Record true © 2013 Porter et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/2.0
title Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
spellingShingle Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
Alison Porter
title_short Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
title_full Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
title_fullStr Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
title_full_unstemmed Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
title_sort Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market
author_id_str_mv fcc861ec479a79f7fb9befb13192238b
author_id_fullname_str_mv fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
author Alison Porter
author2 Alison Porter
Nicholas Mays
Sara E Shaw
Rebecca Rosen
Judith Smith
format Journal article
container_title BMC Health Services Research
container_volume 13
container_issue S1
publishDate 2013
institution Swansea University
issn 1472-6963
doi_str_mv 10.1186/1472-6963-13-s1-s2
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description BackgroundSince 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS patients. We examine the extent to which local commissioners had adopted a market-oriented (transactional) model of commissioning of care for people with long term conditions several years into the latest period of market-oriented reform. The paper also considers the factors that may have inhibited or supported market-oriented behaviour, including the presence of conditions conducive to a health care quasi-market.MethodsWe studied the commissioning of services for people with three long term conditions - diabetes, stroke and dementia - in three English primary care trust (PCT) areas over two years (2010-12). We took a broadly ethnographic approach to understanding the day-to-day practice of commissioning. Data were collected through interviews, observation of meetings and from documents.ResultsIn contrast to a transactional, market-related approach organised around commissioner choice of provider and associated contracting, commissioning was largely relational, based on trust and collaboration with incumbent providers. There was limited sign of commissioners significantly challenging providers, changing providers, or decommissioning services.In none of the service areas were all the conditions for a well functioning quasi-market in health care in place. Choice of provider was generally absent or limited; information on demand and resource requirements was highly imperfect; motivations were complex; and transaction costs uncertain, but likely to be high. It was difficult to divide care into neat units for contracting purposes. As a result, it is scarcely surprising that commissioning practice in relation to all six commissioning developments was dominated by a relational approach.ConclusionsOur findings challenge the notion of a strict separation of commissioners and providers, and instead demonstrate the adaptive persistence of relational commissioning based on continuity of provision, trust and interdependence between commissioners and providers, at least for services for people with long-term conditions.
published_date 2013-05-24T04:07:42Z
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