Recommendation 131

Alternative sources of provision

Commissioners need, wherever possible, to identify and make available alternative sources of provision. This may mean that commissioning has to be undertaken on behalf of consortia of commissioning groups to provide the negotiating weight necessary to achieve a negotiating balance of power with providers.

Commissioners should only decide on models of provision based on the needs and best interests of their patients, in accordance with best practice and with Monitor’s guidance for commissioners in ensuring the continuity of health services. In doing this, commissioners should prioritise those services for which alternative sources of provision should be made available.

NHS England supports commissioning being undertaken collaboratively, where appropriate. NHS England has provided guidance on collaborative commissioning, to support commissioners who wish to collaborate with one another.  It is currently reviewing with clinical commissioning groups whether additional guidance and support would be helpful for 2014/15.


NHS England is supporting commissioners to explore new models of commissioning giving patients, local communities and local clinicians greater opportunities to influence how services are delivered. There will be three key changes to the commissioning system for 2015/16, described below.

In May 2014, NHS England announced plans to work with clinical commissioning groups on the development of new models for the co-commissioning of primary care. 196 clinical commissioning groups submitted an expression of interest. Further guidance on co-commissioning has also been produced Next steps towards primary care co -commissioning, This guidance includes detailed overview of the different co-commissioning models and next steps towards implementation. The first delegated co-commissioning arrangements and joint commissioning arrangements involving a pooled budget are planned to be implemented from 1 April 2015.

NHS England has asked a taskforce to analyse current specialised commissioning arrangements to bring about urgent improvements in the way services are commissioned. This move was instigated to address a number of challenges causing significant pressures across the system, gaining financial control but also ensuring that the services delivered to patients across England are planned and delivered safely and efficiently. The outcome is reflected in NHS England’s planning guidance for 2015/16.

In July 2014 NHS England announced plans to pool funding for key groups across local authorities, clinical commissioning groups and specialised commissioning from April 2015. The aims of this approach, to be known as Integrated Personal Commissioning, will be to test new commissioning and funding models and to explore how individuals can have more control over how the funding is used through personalised care and support planning. NHS England also aims to allow people to commission their own care and support through Personal Health Budgets. From October 2014, those in receipt of NHS Continuing Healthcare have the right to a Personal Health Budget, which will allow care and support to be organised that meets their needs. The NHS Mandate sets an ambitious objective that this should also include people with a long-term condition.