Recommendation 130

Commissioners requirements of providers

Commissioners – not providers – should decide what they want provided. They need to take into account what can be provided, and for that purpose will have to consult clinicians both from potential providers and from elsewhere, and to be willing to receive proposals, but in the end it is the commissioner whose decision must prevail.

We agree with the principle that it is for commissioners to determine what must be provided.  Commissioners will increasingly commission for outcomes, in line with the NHS Outcomes Framework, leaving to providers some of the detail of how the service is delivered to achieve those outcomes.

As part of the reformed commissioning system, there are a range of mechanisms for providers, and particularly their clinicians, to offer advice and proposals to commissioners. Strategic clinical networks, hosted by NHS England, bring together clinicians to drive change and improvements in the areas of cancer, coronary heart disease, mental health, and maternity and children’s services.  In addition, clinical senates bring together clinicians from all sectors of health care, patients and other partners, to give advice to commissioners and providers in their area to help them make the best decisions about healthcare for the populations they represent.

The reforms to the commissioning system will strengthen the ability of commissioners to secure the services they want for their population. 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 are safe, clinically effective and result in a positive experience for patients.


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 supporting continuous improvement in quality. A framework for commissioning for quality, Commissioning for Quality – Views from Commissioners was published in July 2014