Good practice in decommissioning

A new NIHR study uses expert interviews, survey of CCGs, and four case studies of attempts to decommission services. It outlines good-practice principles for leading decommissioning processes and engaging service users and citizens, but concludes that although no simple decommissioning formula exists, successful programmes typically address change management and implementation, evidence and information, and relationships and politics.

Decommissioning health care: identifying best practice through primary and secondary research a prospective mixed-methods study.
Williams I, Harlock J, Robert G, Mannion R, Brearley S & Hall K.
Health Serv Deliv Res 2017;5(22)

See other resources on decommissioning on the Disinvestment page of the Handbook.

Patient Experience Library

My attention has been drawn to the Patient Experience Library –

“UK’s collective intelligence on patient experience, much of which can be quite hard to find. For example, the local Healthwatch network (the biggest single contributor to the knowledge base) publishes thousands of reports every year, but posts them across 150 separate websites, all of which are structured differently, and many of which are poorly maintained. [The Library has] catalogued and indexed the entire reporting output (four years’ worth) which is not available anywhere else in searchable form.”

Access to the complete Library is by subscription, but worth a look to those who need this sort of information.

The nature of evidence in public health decision making

This research into decision making around public health in local authorities demonstrates an interesting parallel to decision making in NHS commissioning processes in CCGs.

Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government
M.P. Kelly L. Atkins C. Littleford G. Leng S. Michie
J Public Health (Oxf) 2017, p1-7. DOI:

NICE has published a number of public health guidelines developed using classical evidence based approaches. Researchers interviewed public health local authority (LA) employees in four LAs about their experiences of implementing these guidelines following the move of public health functions in 2013. Participants reported tensions between evidence based and political decision making, differences in views about what constituted “good” evidence, and that organisational life is an important mediator in the way evidence is used.

“Political decision making does not necessarily align with decision making based on the evidence from the international scientific literature, and local knowledge and local evidence are very important in ways that public health decisions are made.”




Evidence-based policy-making: the view from a commissioner

“As commissioners we are influenced by a vast range of competing factors…research evidence is one of those factors which I value highly, but it doesn’t always help us out as commissioners.”

This blog post by a CCG commissioner describes the real life issues around using research evidence in policy making.

Evidence-based policy-making: the view from a commissioner. Rachel Anthwal, Delivery Director at Bristol Clinical Commissioning Group, 10 April 2017

Referral management schemes: good for whom?

BMJ has done some investigation into referral management systems through FOI requests. It is hoped that these schemes will reduce costs and improve the quality of referrals. Of the 184 CCGs that responded, 72 (39%) said that they currently commissioned some form of referral management scheme.

Read the report here: Referral management schemes: good for whom? BMJ 2017;356:i6856 (NHS OpenAthens ID required)
This has been added to the GP Referrals and demand management Hot Topic page.

Commissioning to prevent falls

Effective commissioning for falls and fracture prevention will reduce demand and improve quality and outcomes. A consensus statement published by PHE compiled by the National Falls Prevention Coordination Group –  Falls and fracture consensus statement: supporting commissioning for prevention  brings together proven approaches to interventions and activities which help to prevent falls and fractures but which are currently not always managed effectively.

Added to the Older People section of the Resources for Specific Populations page.