What happens when GPs engage in commissioning? Two decades of experience in the English NHS

Miller, Rosalind and Peckham, Stephen and Coleman, Anna and McDermott, Imelda and Harrison, Stephen and Checkland, Kath (2015) What happens when GPs engage in commissioning? Two decades of experience in the English NHS. Journal of Health Services Research and Policy, . ISSN 1355-8196. E-ISSN 1758-1060. (doi:https://doi.org/10.1177/1355819615594825) (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

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Official URL
http://dx.doi.org/10.1177/1355819615594825

Abstract

Objective To review the evidence on commissioning schemes involving clinicians, in the United Kingdom (UK) NHS, between 1991 and 2010; report on the extent and impact of clinical engagement; and distil key lessons for the development of such schemes both in the UK and elsewhere. Methods A review of published evidence. Five hundred and fourteen abstracts were obtained from structured searches and screened. Full-text papers were retrieved for UK empirical studies exploring the relationship between commissioners and providers with clinician involvement. Two hundred and eighteen published materials were reviewed. Results The extent of clinical engagement varied between the various schemes. Schemes allowing clinicians to act autonomously were more likely to generate significant engagement, with ‘virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement observed). Engagement of the wider general practitioner (GP) membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Conclusion Evidence for a significant impact of clinical engagement on commissioning outcomes is limited. Initial changes are likely to be small scale and to focus on services in primary care. Engagement of GP members of primary care commissioning organisations is an important determinant of progress, but generates significant transaction costs.

Item Type: Article
Uncontrolled keywords: GP commissioning, primary care organisations, primary care purchasing
Subjects: R Medicine > R Medicine (General) > R729 Types of medical practice > R729.5.G4 General practice
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Tony Rees
Date Deposited: 19 Jun 2015 09:15 UTC
Last Modified: 30 Jun 2016 10:56 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/49083 (The current URI for this page, for reference purposes)
Peckham, Stephen: https://orcid.org/0000-0002-7002-2614
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