Commissioning for quality: experience in an English primary care trust

Judith Strobl (NHS Manchester, Manchester, UK)
Rajan Madhok (NHS Manchester, Manchester, UK)

Clinical Governance: An International Journal

ISSN: 1477-7274

Publication date: 12 October 2012



The purpose of this paper is to describe the experiences of Manchester Primary Care Trust (PCT) of driving improvement in quality and patient safety as commissioners in the English National Health Service (NHS). After the PCT's establishment in late 2006, considerable work was undertaken to develop and promote the role of Commissioner as the custodian of standards of services for its resident population. This required engagement with internal PCT stakeholders and a range of external stakeholders locally, regionally and nationally. The authors' experience should be of interest in the UK, and beyond given that many health systems have, or are moving towards, a commissioner: provider model.


This is a case study using self‐reported observational approach.


The authors' experience showed that commissioners can and should provide the leadership in driving quality improvements and patient safety, within their health systems. However, the challenges must not be underestimated, and the authors share some of the methods they used and lessons they learned.

Research limitations/implications

There is a considerable interest in promoting quality through better commissioning of health care services. However, there is limited research into the impact and effectiveness of using commissioning as a lever. Given that in the NHS, and elsewhere in the world, commissioning is seen as the organising principle for health systems, such research and evaluation should be a priority.

Practical implications

This case study has valuable lessons for the new NHS and the findings are relevant to other health systems. There is a danger that the new NHS will repeat some of the mistakes of the past, and hopefully this case study can help avoid, or limit, the risks.


To the authors' knowledge there is no comparable piece of work, and the data/findings have not been published or reported comprehensively before. The paper should be of value to not just the NHS but to health systems generally, since commissioning seems to be the prevailing model for organising them.



Strobl, J. and Madhok, R. (2012), "Commissioning for quality: experience in an English primary care trust", Clinical Governance: An International Journal, Vol. 17 No. 4, pp. 277-286.

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Copyright © 2012, Emerald Group Publishing Limited

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