Creative commissioning - the future is local

with Professor Mike Morgan

30 Jan 2015 10:30

Many people in England have yet to grasp that there has been a major shift in how and where decisions about their healthcare are made. NHS reforms have resulted in a wholesale transfer of responsibility for commissioning decisions from the Department of Health (DH) to individual Clinical Commissioning Groups (CCGs) via NHS England.

Accountability for the majority of commissioning decisions that relate to respiratory disease now sits with CCGs and is not directed by either DH or NHS England.

The NHS in England is therefore a federation of over two hundred local commissioners who have effective autonomy over their commissioning priorities. In some areas, such as dementia or cancer, there are clear directives from NHS England, and a supporting structure in the form of strategic networks, to deliver standard service improvement.

For disease areas where these do not exist, CCGs have much greater choice in the nature and scale of service that they should provide. This has already led to variations in provision according to local need or simply by interest.

It is fast becoming clear that, unless there is a major political shift in emphasis, respiratory disease will not be prioritised specifically by NHS England, and CCGs will need to be influenced more explicitly by local need.

To a limited extent this is already happening where local stakeholder groups are interacting with CCGs in the form of an informal network and some individuals or groups of CCGs have already identified COPD as a priority in their five-year strategic plans. This is good news and likely to be successful, particularly if their proposed intentions fit in with the models suggested in the recently published Five Year Forward View which favours vertical integration and specialist interaction with primary care – see for more details.

Whilst there is likely to be sufficient intrinsic justification for CCGs to develop sustained interest in respiratory conditions, this won’t happen automatically. There is still much to be done by us, as specialist healthcare professionals, to communicate consistently the importance of developing clinically led, patient-centred quality respiratory care to the 200 or so CCGs in England.

Health and Wellbeing Boards and local networks are an obvious conduit for influence. And around the country there are examples of patient organisations and stakeholder groups already having a positive influence on local commissioning policy, such as in Leeds and the South East Coast region.

In Leeds, practice nurses Sarah Anderson and Melissa Canavan, have been making the most of social media to spread the word, with a blog (, Twitter feed (@RespNetwork), Facebook page ( and a YouTube video (  Thanks to their dedication, the newly formed Leeds Respiratory Network is now working with local CCGs to improve asthma services in the area. Enhanced communication between primary and secondary care and collaboration with a broad network of healthcare professionals – not just practice nurses, but also school nurses, prison nurses, community and secondary care nurses, hospice nurses, community matrons and pharmacists – is already having a positive impact.

And the South East Coast Respiratory Programme’s regular newsletter ‘Breathing Matters’ brings together news and events from the respiratory community across the region, with updates on the national respiratory programme and educational articles on key issues. It’s making great strides in helping local commissioners see what can be achieved for their respiratory patients – see for more details.

It may be that similar dialogues are ongoing in your area, or perhaps you have yet to explore how a local respiratory network could help integrate and improve services locally?

What is certain is that the more we can communicate the importance of addressing clinical variation and inconsistencies in respiratory care, the better. So please sign up for our webinar on Friday 30th January at 10.30am via

where I’ll discuss these issues in more detail, and afterwards share your online feedback on Respiratory Futures.

Whatever your current situation, with your input we are confident that Respiratory Futures will build a library of successful local experiences, enabling groups to share best practice and helping others get off the ground.

Mike Morgan, January 2015