Recommendation 132

Commissioners monitoring contract performance


Commissioners must have the capacity to monitor the performance of every commissioning contract on a continuing basis during the contract period:

  • Such monitoring may include requiring quality information generated by the provider.
  • Commissioners must also have the capacity to undertake their own (or independent) audits, inspections, and investigations. These should, where appropriate, include investigation of individual cases and reviews of groups of cases.
  • The possession of accurate, relevant, and useable information from which the safety and quality of a service can be ascertained is the vital key to effective commissioning, as it is to effective regulation.
  • Monitoring needs to embrace both compliance with the fundamental standards and with any enhanced standards adopted. In the case of the latter, they will be the only source of monitoring, leaving the healthcare regulator to focus on fundamental standards.

Commissioning support services exist to provide this resource and expertise. Commissioning support services typically include:

  • Health Needs Assessment
  • business intelligence
  • support for redesign
  • communications and public and patient engagement
  • procurement and market management (agreeing contracts)
  • provider management (monitoring contracts)

These functions cover the key elements of this recommendation regarding monitoring quality information, including compliance with fundamental and enhanced standards, and undertaking audits.

NHS England will include this effective contract management and monitoring as an objective in its Commissioning Support Services Strategy and underpinning products, such as quality standards, continuity of service, and procurement vehicles.

NHS England and clinical commissioning groups are developing a framework for commissioning for quality which will set out the steps that commissioners should take to assure themselves and their patients that the services that they are commissioning are safe, clinically effective and result in a positive experience for patients.


NHS England is introducing a Lead Provider Framework agreement for commissioning support services to ensure that clinical commissioning groups and other commissioners have a choice of the best and most efficient commissioning support suppliers. For further information on the Framework see recommendation 127.

NHS England has continued to develop relevant guidance and tools for clinical commissioning groups, to support them in monitoring the quality of service provision and in driving continuous improvement in quality. A framework for commissioning for quality, Commissioning for Quality – Views from Commissioners was published in July 2014.