Investigating and assisting the practice of healthcare commissioning in the United Kingdom

IntroductionThe United Kingdom National Health Service (the NHS) is radically restructuring its arrangements for planning, procuring, evaluating healthcare provision (i.e. ‘commissioning’), devolving this responsibility to newly created Clinical Commissioning Groups (CCG’s), composed of local family physicians (GP’s). GP-led commissioning is a new practice. A Practice Research approach might assist the growth of local expertise, contribute acquired knowledge to the general practice of commissioning and stimulate the development of new theoretical and methodological approaches.Purpose and aimsTo engage with clinical commissioning groups (CCG’s), we aim to provide a preliminary conceptualisation of the problem situation; second, to develop preliminary ideas on a problem solving approach that can be adapted to the landscape of commissioning as it evolves; and, third, to inform our own ongoing programme of research and understanding. Methodological approachSynthesise model of intended research from recent literature. Explore multiple perspectives influencing mental models of the problem situation. FindingsThe three forms of perspective explored illustrate social and political considerations which interfere with the rationality of the new practice.Conclusion: Value and Implications We offer a model of the ‘physiology’ of practice research applied to commissioning, showing how its interacting parts function as an organic whole.We make no recommendations on specific healthcare commissioning objectives but we have shown how healthcare commissioning as a problem situation can be described from multiple perspectives and we suggest that the discipline of taking these perspectives on the commissioning situation has the capacity to enrich understanding, comprehensive diagnosis and accurate prognosis for the health economy concerned. We hope to develop this theme in our future projects.