Developing Relational Commissioning #4 – Enablers to Implementing a New Approach to Commissioning

Thinking differently about commissioning Kings Fund (2022)

Enablers to implementing a new approach to commissioning

Effective collective leadership and long-established relationships

A history of collaboration and well-established relationships between system leaders.
Leaders who role-model the behaviours they want to see in the system in the way they collaborate as a senior team.

Clear vision

An agreed vision for ways of working to which senior leaders from across the system are fully committed. The vision provides an important backstop when organisations inevitably revert to siloed behaviours in pressured situations.
Willingness to take risks to achieve that vision, including pushing forward with an approach despite challenges such as potential conflicts of interest.

Local geography

A relatively ‘closed’ nature of the system enables providers and commissioners to effectively collaborate to bring about change.
Co-terminosity with the local authority enabled collaboration across health and social care.
A strong sense of local identity and attachment to ‘place’.

Finance and performance issues

Financial and performance difficulties in some cases created the initial impetus to start to work differently as a system.
More recently, strong performance and a good reputation frees these commissioners from interference by national bodies and empowers them to challenge national requirements and guidelines.

Investment to support change

External support – including coaching for leaders, facilitation support for collaborative decision-making structures and transition funding to support the development of new initiatives.
Investment of staff time and resources in the development of relationships and organisational development.