Joint commissioning for integrated care

What is joint commissioning?

Joint commissioning is the mechanism by which local partners can execute their vision and strategy for integrated care. Although there is no single definition or ‘right way’, in practice joint commissioning means health and social care organisations collaborating and sharing responsibility for integrated care services and their outcomes. This can involve organisations working in partnership at all stages of the commissioning process, from the assessment of needs, to the planning and procuring of services, and the monitoring of outcomes.

The activities of joint commissioning can be both strategic and tactical. They involve deciding how local services can best be delivered to meet the needs of local people, who should provide the services and where, how the services will be paid for, and what outcomes will be expected. Bringing together local resources provides the scope for economies of scale and supports place-based integrated care. Joint commissioning also helps tackle the barriers to integrated care.

Local authorities and clinical commissioning groups hold the purse strings. For integrated care, however, joint commissioning strategy is best developed with the involvement of health and social care providers from across the system, clinical leaders and especially services users.

  • Video transcript Open

    Joint commissioning for integrated care is when local commissioners are collaborating to bring together health and social care services, and where they share the responsibility for planning and delivering better care outcomes.

    This can involve organisations working in partnership at all stages of the commissioning process, from the assessment of needs, to the planning and procuring of services, and the monitoring of outcomes.

    The activities of joint commissioning can be both strategic and tactical.

    They involve deciding how local services can best be delivered to meet the needs of local people, who should provide the services and where, how the services will be paid for, and what outcomes will be expected.

    Overall, joint commissioning aims to:

    • Deliver personalised services, by involving people in their own care and care decisions;
    • Transform people’s experiences from fragmented care to coordinated care through service re-design and improved care pathways;
    • Improve care outcomes by expanding prevention and early intervention services, especially at home or in the community; and
    • To produce efficiencies, by reducing waste and service duplication.

    Emerging evidence from case studies suggests a number of factors are associated with successful joint commissioning.

    These include:

    • System leadership: active partnerships of commissioners and providers, with a shared vision for integrated care and good working relationships
    • A single joint commissioning team with clearly articulated responsibilities
    • The pooling or alignment of local health and social care budgets
    • Processes for joint commissioning: including dialogue with local providers, involvement of clinical professionals and service users, as well as asset-based approaches to draw on other community resources, such as the voluntary sector.

    Joint commissioning is a key enabler of integrated care.

    For commissioners, strong working relationships and taking a strategic, whole system perspective are essential to doing joint commissioning well.

Explore joint commissioning

Why does joint commissioning matter for integrated care?

Commissioning integrated services delivers the integrated service model and the benefits of integrated care. With each local health and care system including a complex array of providers, joint commissioning bridges the gaps between organisations and settings and makes clearer how service users should journey through the network of services.

Joint commissioning aims to:

  • deliver personalised services, by involving people in their own care and care decisions
  • transform people’s experiences from fragmented care to coordinated care through service re-design and improved care pathways
  • improve care outcomes by expanding prevention and early intervention services, especially at home or in the community
  • produce efficiencies by reducing waste and service duplication

What does joint commissioning need to succeed?

Studies of joint commissioning and emerging evidence from case studies suggest a number of factors are associated with successful joint commissioning. These include good system leadership, and a combination of formalised structures and processes.

System leadership:

  • Active partnership working amongst system leaders: formal arrangements and behaviours that demonstrate expectations for joint working across the system
  • A clear vision for integrated care and an agreed service model, based on a joint strategic needs assessment and/or the local health and wellbeing strategy
  • Effective system governance and oversight by system leaders to monitor progress

Structures for joint commissioning:

  • A single team of joint commissioners, ideally co-located
  • Clearly articulated lead commissioning responsibilities, where these are used
  • Alignment or pooling of local health and social care resources, enabled by a Section 75 agreement between a local authority and clinical commissioning group
  • Contracts with providers that correspond with the system and service changes expected, and which include relevant outcomes metrics and incentives

Processes for joint commissioning:

  • Dialogue with local providers, clinical professionals and service users to shape the delivery of the service model and integrated care services
  • Use of evidence for designing clinical pathways, moving away from a focus on treating single diseases to coordinating complex care
  • Asset-based approaches to identifying and incorporating other local resources, such as the voluntary sector

What is the evidence for outcomes and impact?

Joint commissioning represents a unique way of working, with no single coherent model and a great deal of variability from place to place. It should be understood as an enabler of integrated care.

From case examples, we are observing that joint commissioning is delivering key elements of integrated care:

  • Joined-up services: providers have come together to deliver integrated care through outcomes-based contracts
  • Personalisation: service users are reporting greater involvement in decisions about their care, especially in care planning
  • Improvements in quality: service users are reporting better experiences of care, with more care being provided closer to home
  • Greater connectivity: improved information sharing between providers
  • Reduced demand: some integrated care interventions are demonstrating less demand for emergency and acute care, such as Single Point of Access and telephone triage
  • Efficiencies: some efficiencies are being realised from changing the way people access care, especially for urgent needs, and through better care coordination, including prevention services