Policy Research Unit
Policy Research Unit
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Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012

The Health and Social Care Act 2012 (‘HSCA 2012’) introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England’s policy document, The Five Year Forward View (‘5YFV’) of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation.

Read the BMJ open article>>

PRUComm Research Review 2017

This is the fifth annual review of our research and provides a brief overview of our current research activities.

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Review of the Quality and Outcomes Framework in England

This report reviews the evidence of effectiveness of Quality and Outcomes Framework (QOF) in the context of a changing policy landscape

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Improving GP recruitment and retention needs a long-term strategy

This report is an evidence synthesis on GP recruitment, retention and re-employment. 

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Alliance contracting, prime contracting and outcome based contracting: What can the NHS learn from elsewhere?

This report summarises the findings of a literature review of the available evidence concerning the characteristics of these new contractual models and their implementation in other sectors. 

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PRUComm Research Review August 2016

This is the fourth annual review of our research and provides a brief overview of our current research activities.

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Public Health and Obesity in England – the New Infrastructure Examined

The PHOENIX project aims to examine the impact of structural changes to the health and care system in England on the functioning of the public health system, and on the approaches taken to improving the public’s health.

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Commissioning through competition and cooperation

This is a final report of our project investigating how commissioners in local health systems managed the interplay of competition and cooperation in their local health economies, looking at acute and community health services.

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PRUComm evidence to the Health Committee

PRUComm provided written evidence to the House of Commons Health Committee's inquiry into Primary Care. The written evidence can be accessed here [pdf] and the Committee's report can be accessed here [pdf] 

Understanding primary care co-commissioning: Uptake, scope of activity and process of change

This report presents early findings from the third phase of a longitudinal study following the development of CCGs since their inception in 2011. The over-arching aim of this phase of the project is to explore the significant changes to the work of CCGs as they took varying levels of new responsibility for commissioning primary care services from April 2015.

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Exploring the GP ‘added value’ in commissioning: What works, in what circumstances, and how?

In this study we explored the potential added value that clinicians, specifically GPs, bring to the commissioning process in interviews, and followed this up with observations of commissioners at work. Our research used ‘Realist Evaluation’ (Pawson & Tilley, 1997) which involves: seeking out participants ‘programme theories’ as to how a particular policy or programme will bring about the desired outcomes; exploring the extent to which these programme theories ‘work’ in the real world; and examining in detail the mechanisms and contexts which underpin them. We applied this approach to GPs roles in CCGs, using interviews to find out what CCG leaders believe are the key aspects of their contribution to commissioning. We then observed a wide range of meetings in order to explore the extent to which the claims they made were borne out in practice, and to try to elucidate the important conditions which supported their roles.

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Eighth National GP Worklife Survey report

Since 1998, The University of Manchester has undertaken regular surveys of the perceptions of GPs in England about their working lives. These surveys provide important independent evidence for the Department of Health, which contributes to informing policy around GP retention and recruitment.

The results of the 8th National GP Worklife Survey are published today. The survey was undertaken in the spring and summer of 2015 and responses were received from over 2,600 GPs.

The respondents reported the lowest levels of job satisfaction since before the introduction of their new contract in 2004, the highest levels of stress since the start of the survey series, and an increase since three years ago in the proportion of GPs intending to quit direct patient care within the next five years.

The survey was carried out by the Manchester Centre for Health Economics in the Institute of Population Health, on behalf of the Policy Research Unit in Commissioning and the Health Care System (PRUComm), and the report is available here (PDF 784KB).

PRUComm Research Review August 2015

Over the last year PRUComm’s research activities have continued to expand culminating in a new phase of work examining co-commissioning of primary care by CGGs and NHS England and additional short research projects on primary care to include new projects on the public health system in England and research on competition and collaboration. We have also continued our research on aspects of the functioning of the health care system with work on contracting and competition and also continued to examine the developing public health system. This is our third annual review of research and provides a brief overview of our current research activities.

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The Multiple Purposes of Policy Piloting and Their Consequences: Three Examples from National Health and Social Care Policy in England

Pauline Allen's paper looking at policy piloting using three case studies from health and social care was quoted in recent Guardian's article.

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Pauline Allen's paper quoted in recent Guardian's article. Read more>> - See more at: http://www.prucomm.ac.uk/home#sthash.r8tphlPA.dpuf
The journey to the common: what is the role of the voluntary sector?

Blog by Anna Coleman & Julia Segar

recent publication by the New Local Government Network (NLGN) looked at how local councils are preparing for the future and suggests depressingly that“there is simply no way that local government can reach 2018 let alone 2020 while still delivering the full range and quality of services currently on offer”(p6). Simply put, we have an ageing population, with associated increasing demand for care services and draconian cuts in council budgets. The NLGN suggest we could be facing a future of “private affluence and public squalor”. However, it is not all doom and gloom. Perhaps austerity can be a strong stimulus for innovation? How would this work I hear you ask?

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Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study

Professor Stephen Peckham (Director of PRUComm) is the lead author of a recently published NIHR HS&DR funded research which explored the role and impact of patient and public engagement and involvement in commissioning for people with LTCs.

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Changing the ties that bind? The emerging role and identity of GPs and managers in CCGs

Blog by Julia Segar

GPs now lead the process of planning, designing and purchasing health services for their local populations. The rationale for this was the notion that GPs are on the ‘frontline’ of patient care so they know and understand their patients’ needs and in turn are trusted by their patients. We have been tracking and researching these changes and in our Sage Open paper we examine the impact of these reforms on the roles and identities GPs and managers. 

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Make, buy or ally? Commissioning support in the new NHS

Blog by Kath Checkland

Our recent CCG research published in BMJ Open  explored the early stages of this transition, using contracting theory to try to understand how CCGs were approaching the decisions they needed to make: should they ‘make’, ‘buy’ or ‘ally’? We found that some CCGs were reluctant to outsource commissioning support, fearing that they would lose local knowledge and trusted local relationships. 

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Just what the Doctor ordered? The ‘added value’ GPs bring to clinical commissioning

Blog by Neil Perkins

Our paper published by the British Journal of General Practice looks at what ‘added value’ GPs think they bring now they are responsible for commissioning healthcare in their local communities.

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Clinical Commissioning Groups: one year on

Seminar hosted by PRUCommThe Nuffield Trust and the King’s Fund on 1st May at The King’s Fund, London. 

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