Commissioning

Commissioning is the ongoing process of planning, setting up, and overseeing healthcare services. It involves many steps, from assessing the health needs of a population to designing patient care pathways, specifying services, negotiating contracts, and continually monitoring quality.

The goal of commissioning is to improve the physical and mental health of the entire population while reducing health inequalities within specific communities. Using data-driven planning and population health management, commissioning helps identify high-risk groups, design targeted interventions to prevent illness, and improve care for those with long-term health conditions.

To conduct commissioning, including population health management, national datasets are linked with GP data via pseudonymised NHS Numbers. This builds a linked dataset to helps us to population needs and informs inform the commissioning of services and interventions.

NHS Mid and South Essex uses commissioning processes to plan, purchase and monitor health and care services for our local population. This involves a range of activities, including:

Population health management: Analysing data to identify groups most at risk, enabling tailored interventions and resource allocation to reduce health inequalities. Further information can be found here.
Data quality and validation: Ensuring data accuracy through regular checks, supporting informed decisions and high-quality care.
Health needs assessment: Identifying disease prevalence and healthcare needs within the local population.
Understanding at-risk cohorts: Recognising groups likely to need high-cost services, enabling proactive care and resource planning.
Pathway design: Developing patient care pathways based on data insights, with a focus on preventing illness and managing demand effectively.
Pathway analysis: Examining patient journeys across health and social care to enhance pathway efficiency.
Service redesign and modelling: Using data to monitor how healthcare services interact and adjusting improve patient flow and outcomes.
Demand management: Analysing data to predict care needs, helping secondary care plan capacity and ensure patients receive timely care.
Medication and outcome tracking: Monitoring trends in medication prescribing and effectiveness, as well as mortality rates, to align services with patient needs and improve patient outcomes.

How it works

NHS Mid and South Essex implements commissioning through a structured, data-driven approach. This begins with a comprehensive health needs assessment, combining national datasets with GP data via pseudonymised NHS Numbers to create a linked dataset. This linked data provides insight into population health trends, guiding service planning and interventions.

Using population health management, we segment the population to identify high-risk groups, enabling targeted care and focusing resources on those with the greatest need, thereby reducing health inequalities across communities. To support informed, high-quality decision-making, we continually validate data for accuracy.

From this information, we generate reports and dashboards that track quality metrics across acute, community, and mental health services, laying the groundwork for effective pathway design, resource allocation, and service redesign.

This streamlined approach ensures that services are available when and where they’re most needed, ultimately leading to improved patient care, more efficient use of resources, and better health outcomes for our population.

Expected outcomes

The main outcomes of effective commissioning include:

Better health outcomes: Enhanced physical and mental health, and a reduction in health inequalities. By focusing on the broader determinants of health, commissioning helps address factors like socio-economic conditions that impact long-term health.
Reduced likelihood of people getting ill: Addressing the wider factors that affect health, such as social and economic conditions, to help prevent recurring health issues. This involves working closely with communities and partner agencies.
Early intervention and prevention: Supporting disease prevention at every level—from early intervention to managing ongoing conditions—helps to prevent serious health issues before they arise.
Tracking health trends and economic impact: By monitoring changes in health over time, we can understand how health trends affect both local communities and the economy.

The use of commissioning data enables the improved planning by better understanding patient flow through the healthcare system. This enables commissioners to design effective care pathways and set priorities that address specific needs. Key activities include:

Provider reporting and monitoring: Generating reports on providers, finances, and readmissions, alongside dashboards at both programme and GP practice levels, to support informed decisions.
Quality and performance analysis: Monitoring quality across sectors, including acute, community, and mental health services, including clinical coding reviews, audits, and benchmarking against other ICBs on key care quality and performance metrics.
Reduce emergency readmissions: Lower avoidable readmissions by identifying frequent emergency service users and providing early interventions to improve care quality.
Budget and contract management: Reporting down to GP practice level, contract modelling, and demand management to ensure efficient use of resources and adequate capacity in secondary care.
Pathway design and demand management: Using demand data to predict pathway impact, support capacity planning, and improve patient flow within the system.
Data quality and validation: Ensuring the accuracy and reliability of data through regular checks, contributing to overall data quality in decision-making.
Service optimisation: Identifying low-priority procedures suitable to be delivered in the community to reduce hospital referrals and improve access by addressing areas with high demand but limited availability.
Health outcome tracking: Monitoring trends in mortality, medication effectiveness, and prescribing habits to align services with patient needs, including managing polypharmacy and improving early interventions for frequent emergency service users.
Population health insights: Supporting better understanding of local population characteristics, helping commissioners tailor services to specific health outcomes and reduce premature mortality through targeted primary care interventions.