Area of work:

Clinician-led commissioning represents one of the more radical elements of the Government’s NHS reforms enacted in the 2012 Health and Social Care Act. We have an established expertise in the area of commissioning and have an ongoing programme of work in this field, drawing on national and international evidence and best practice. We aim to support policy-makers and practitioners as groups of clinicians get set to take control of around £60 billion of the NHS budget.

Under reforms contained in the Health and Social Care Act 2012 clinical commissioning groups took over responsibility for commissioning the majority of NHS services in England, in April 2013.

All GPs in England were required to join one of the clinical commissioning groups, which began their new statutory responsibilities from 2013/14, supported by NHS England.

The Nuffield Trust is well placed to help ensure that the implementation of the reforms draws on the best available evidence – not only from the history of primary care-led commissioning in the NHS in England, where our experts have two decades' worth of experience in research and development support, but also from changes to the way international health systems commission health services.

We have conducted a number of studies into international approaches to primary care-led commissioning, including in the United States, Australia and New Zealand.

At the time of the publication of the NHS White Paper in July 2010, we visited four doctor-led groups in California and discovered a number of important lessons for the NHS in England. The findings are published in our report: GP commissioning: insights from medical groups in the United States (January 2011).

Supporting the development of commissioning groups

To track the progress of the new clinical commissioning groups, the Nuffield Trust, in collaboration with The King’s Fund, are studying six groups from across England. The study began in September 2012 and will last for three years.

In the first year, the work focused on understanding the emerging structures and governance of clinical commissioning groups, paying particular attention to the relationships that are developing between governing bodies and local GP practices. Findings from the first phase of the study were published in the report: Clinical commissioning groups: supporting improvement in general practice (Nuffield Trust and The King's Fund, July 2013).

Developing commissioning support

Good quality commissioning depends on local commissioners being aware of the potential of different kinds of providers and service models. The voluntary sector has provided services for many years to parts of the NHS, for example mental health services or palliative care services, and is looking to expand its role into commissioning support.

We have published a report with funding from Macmillan Cancer Support and support from NHS England, ACEVO and Neurological Commissioning Support, exploring the potential for the voluntary sector to become more involved with commissioning support, particularly where the voluntary sector has expertise, for example in conducting needs-assessments, service re-design and public and patient engagement.

The report: Role of the voluntary sector in providing commissioning support (Nuffield Trust, November 2013), authored by Holly Holder, explores how local commissioners and NHS England can make best use of the voluntary sector in improving the standard of commissioning support.

Supporting national commissioners

We are carrying out policy analysis to inform the development of NHS England, drawing on research and practice in a selection of nations within the Organisation for Economic Co-operation and Development (OECD), and publishing analysis of the criteria needed for the board to work most effectively. A report will be published in 2014.

Earlier work on commissioning

We regularly work in partnership with other high-profile national organisations in carrying out evidence-based analysis of the issues associated with clinically-led commissioning.

In June 2010 we published: Giving GPs budgets for commissioning: what needs to be done?, a joint publication with the NHS Alliance, National Association of Primary Care, Royal College of General Practitioners, The King’s Fund and the NHS Confederation.

Another completed partnership project with the NHS Alliance examined how practice-based commissioning (PBC) could be extended to involve specialists and other clinicians.

In November 2009 we published: Beyond practice-based commissioning: the local clinical partnership, which explores the possibility of developing multi-specialty groups of clinicians (GPs as well as hospital-based specialists) to take responsibility for the provision and commissioning of local health care.

Project outputs


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