Models of commissioning health services in the British National Health Service: a literature review

The commissioning of health services is an under-researched area and yet it is critical to the way services meet health needs and to the quality of ca re. Recent emphasis in the United Kingdom and elsewhere has been on a 'prim ary care led National Health Service', particularly on locality commissioni ng through primary care groups, However, there are other models of commissi oning using 'programmes of care' (focused on diseases or patient groups rat her than geography) which may offer greater benefits. There is little resea rch comparing the benefits and costs of these models, and most are not even clearly enough described to be replicated. There will always be a politica l dimension to models of commissioning, dependent, for example, on the bala nce of power in the decision-making process. None the less, a broader knowl edge of possible models and a willingness to evaluate rigorously are needed if commissioning of health services is to result in better patient care.