A10 - Four Levels Of NHS Commissioning

A6 - Strategic Commissioning
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A6 - Joint Commissioning Matrix
A matrix analysis tool to identify strategic approach to commissioning across agencies

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4 - Levels Of Commissioning

  • - Did you know? -

Responsibility for commissioning must be placed at the most appropriate level.  


Every level of commissioning must remain grounded in what matters to the people using the services.




Individual level - Commissioning at this level may be done by the individual, a family carer, an independent broker, a service manager or a combination of these. It is the government's intention that, at the individual level, service users and carers themselves should increasingly assume the lead role in commissioning services to meet their own individual needs and aspirations. The budget holding lead professional is an early example of this transition. 


Local level - including practice-based commissioning or (networks of) schools. The aim of locality level commissioning is generally to meet the particular requirements of the local population and requires a focus on the community dimension.   



Strategic level - At strategic levels, commissioners determine how to use available resources on the basis of needs analysis and evaluating existing services, past performance and notable practice elsewhere. Strategic commissioning takes place over longer time frames, sometimes 10 years ahead, preparing for major service changes and patterns of work.  

Joint commissioning between two or more partners may be strategically-led within Children’s Trust arrangements or co-ordinated through Strategic Health Authorities.  

Regional/sub-regional level - The more specialist the service and the lower its volume, the higher the level at which it is most appropriately commissioned. Some complex and acute needs will therefore often be most effectively met when Children’s Trusts work together, maybe pooling top-sliced budgets.


Did you know?

The main regional commissioning unit for health is Specialised Commissioning, hosted by Leicestershire and Rutland County PCT. They will commission to meet complex CAMHS needs, improve outcomes for young cancer patients and will commission some aspects of antenatal screening.