Developing Relational Commissioning #6 – Implications for Systems, Policy and Practice

Thinking differently about commissioning Kings Fund (2022)

TBAC summary (print).pdf (kingsfund.org.uk)

• Local systems need to invest in developing relationships and changing ingrained behaviours. Relational commissioning requires strong relationships between commissioners and providers from all sectors.
• These relationships will not develop well without investment in organisational development and the commitment of staff time to relationship-building. Moving away from the market requires a change in the culture within commissioners and providers that has been built up over the past 30 years – a challenge that should not be underestimated.
• Agreeing a set of behaviours that will underpin partnership working, principles and behaviours, is a useful first step, a crucial fall-back when difficult decisions had to be made and organisations were (inevitably) tempted to revert to protecting their organisational interests. Pooling sovereignty and being comfortable with giving up power – along with a commitment to transparency and consensus decision-making processes – were key underpinning behaviours in all sites. Back-up arrangements were also important where consensus could not be reached – for example, a voting
• Change will not happen without effective experienced motivated leadership, role-modelling and senior-level commitment across the system. They are times when it is required to confidently push forward with local solutions rather than looking to national bodies for guidance.
• Collaboration depends on relationships, and systems should focus first on the areas most amenable to change. Collaboration can breed collaboration, so success in addressing one ‘collaboration frontier’ and particularly amenable issues across that frontier may breed further success in future in areas that are less amenable to change.
• New procurement approaches and local incentives can be adjusted to support rather than inhibit collaboration approaches to support a more relational way of working. However, these were a fall-back; the main way change happened in these systems was through partners having a different type of conversation, rather than through detailed contract development and enforcement activity
• Expect double running in decision-making and assurance processes.
• A system-wide approach to recruitment can help embed new ways of working. Our case studies show that staff roles are changing as the commissioning philosophy evolves. Some commissioning staff are also becoming more of a ‘system’ rather than ‘organisation’ resource and the skills needed by finance staff in particular are changing. Thinking about system needs when recruiting new staff is a key part of embedding and spreading the approach.
• Planning skills and the ability to look at population rather than organisational needs remain important. As system-wide approaches develop, it is important that local systems do not forget the importance of commissioning skills in local planning. Commissioners can bring a unique population focus and skills in planning, service procurement, cross-sector pathway design and monitoring that remain essential.
• Share good practice widely.
• Share feedback. Complete the commissioning from IROs, SWs, children, family
• Direct relationships with providers rather than representative body.
• Local collaboration between commissioners and providers at place level brings significant benefits.