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This Case Study outlines some aspects of how healthcare may be developed in a manner that embraces improved sensitivity to the needs of individuals and local communities; improved efficiency, quality and effectiveness of services; improved equity that strives for the fair dispersal of limited resources according to need and improved cohesion between different health and social services. It encompasses models of commissioning at district, locality and practice levels, and challenges several assertions made by politicians from both the Conservative and Labour parties. It offers a logical means of developing a primary care‐led NHS that is consistent with a quest for equity, and that truly supports the separation of purchasing from commissioning.

This article is based on a review of reported studies of joint commissioning in practice, which are surprisingly few in number. It concludes that there is little solid evidence that the process leads to benefits for service users, but there is evidence of its resulting in improved inter‐agency working. A second article in a subsequent issue of this journal will go on to consider whether the new partnership flexibilities offer the potential to learn from this evidence.

Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for Project Leaders by the Department of Health in 1995, and stemming from the roots of joint planning and joint finance way back in the mid‐1970s. Achievements have generally not been spectacular, but the issue is now squarely back on the policy stage with a rebranding: ‘integrated commissioning’. This implies a shift from ad hoc and opportunistic partnering to something more systemic and long‐term. However, the policy context is now very different, and the scale of ambition hugely heightened. This article examines whether integrated commissioning is an idea whose time has come.

Examines the relationships between the macro‐, meso‐, and micro‐levels in the NHS at the end of the fundholding period and considers their contemporary implications for primary care groups (PCGs) and local health care co‐operatives (LHCCs). Fundholding achieved some success in challenging the way in which services were provided at the micro‐level (the practice), but had a less marked effect in terms of changing service provision at the health authority (meso‐) level or in developing collaborative working with trusts and health authorities in strategic decision making. The health authorities prioritized alternative models of devolved commissioning. Trusts regarded fundholders as a distraction who exerted influence and commanded trust management time disproportionate to their “market share”. PCGs and LHCCs represent a shift back to the meso‐level in service planning and purchasing. As such there is a risk that the micro‐level benefits of fundholding and other forms of devolved commissioning will be lost, while uncertainties remain regarding the capacity of PCGs and LHCCs to incorporate GPs into a collaborative approach to strategic decision making.

The new local government performance framework, in combination with the move towards greater personalisation in services, creates a radically new funding environment for housing with care and support. From the Public Service Agreement (PSA) on achieving settled accommodation for individuals at risk of exclusion, through to the impact of local joint strategic needs asessments and individual budgets, the principles and mechanisms of the new joint commissioning culture create more opportunities for providers to articulate the needs of the client group served, and to assert the case for more joined‐up and responsive services. This may require different skills and new styles of leadership at local level, and providers who have become adept at being competitors may need to re‐discover the skills of partnership. Meanwhile, new social exclusion policy frameworks are emerging for supported accommodation, which can support moves away from institutional care for those with mental health problems.

This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning.

A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five “best practice” sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups.

Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties.

Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked.

It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop.

This is one of the first large‐scale studies of joint commissioning conducted in England.

This Case Study examines a practical example of joint commissioning in action, in Easington, County Durham. It explores the collaborative processes and particularly the contribution of groups operating at strategic (district) and operational (village) levels. Key individuals made important contributions to the development of a truly ‘partnership’ way of working. Impacts on services began to be made but in the period of study this was more ad hoc than systematic. In spite of some tensions between the different levels of decision making and in the face of further organisational change, the challenge for Easington is to sustain the progress made and to move forward by making further inroads into needs which span various agencies' responsibilities.

The purpose of this paper is to explore change within the commissioning of third sector mental health services in England.

A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation.

Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners’ capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors.

The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought.

To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes.

This research adds to the limited body of empirical work regarding commissioning in mental health.

The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care.

Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken.

Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident.

This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity.

This conceptually‐focused paper looks at particular changes implemented in the UK National Health Service. The specific context is the creation of a new organisational form: the primary care group, which brings together general practitioners and other primary care staff in a given locality. The paper attempts to examine the consequences, for the development of these groups, of the shift from competition (in the internal market) to relationships based on collaboration and partnership. The broad policy objectives envisage much greater emphasis on working in partnership, participating in strategy and planning (via new health improvement programmes), developing joint working, and promoting the integration of service delivery. A relationship marketing perspective is explored as one way of conceptualising the development of new relationships between primary care groups, health authorities, local authorities, trusts and other agencies and the paper suggests that relationship marketing offers a way of facilitating policy change.