Level 1 commissioning course is designed for field representatives. As a field representative, you need to know about commissioning in order to give you a clear picture of how your products and services fit into the health economy of the NHS locality in which you work. It isn't vital to know all about commissioning, as commissioners tend not to get involved in choice of specific products and services.

Why is this important to me?

  • Commissioners within the NHS and in social services are the organisations who are not only responsible for co-designing the care packages but they also manage the funding of the services being delivered.
  • For companies providing resources and services to the NHS, understanding commissioning is very important as commissioners can open up new opportunities by funding avenues of service provision that are different to those that currently exist.
  • Equally, commissioners could stop commissioning pathways that use particular products or services.

Did you know?
Understanding how resources and services are commissioned will give you a better insight into how your products could best fit into the needs of the local health and care economy.



What is Health and Care commissioning?

  • Commissioning is the process of planning the delivery of health and care services for the local population.
  • Commissioners are specialists in health and care planning.
  • They have to understand the process of commissioning effective and safe services and to do this, they need to be able to understand how services are arranged in the locality and how these services fit together with those of neighbouring heath economies.
  • A good understanding of the current providers of health and care services is very important, as is a comprehensive understanding of the current and future health and care needs of the local population.

Did you know?
When commissioning is carried out effectively, the process is meant to ensure that patients have access to the right care, in the right place, at the right time.

How does commissioning work?

Those responsible for commissioning the health and care of the local population need to be able to do the following:

  • Assess the health and care needs of the local population.
  • Decide what services are required to meet these health and care needs.
  • Describe a process by which these health and care services can be delivered by health and care providers, such as GPs, hospitals or other health and care providers.

Did you know?
Commissioners don’t need to be clinically trained, as they will work alongside clinical or social care specialists to determine the safest and most effective pathway for their patients and clients.

Commissioning – assessing the process

  • Processes need to be in place to measure the safety and effectiveness (clinical and economic) of the health and care services being made available by these commissioned providers (such as hospitals, community mental health trusts and Social Services).
  • Assurance: NHS England has a responsibility to assure themselves that clinical commissioning groups (CCGs) are fit for purpose and improving health outcomes.
  • Development: NHS England must help support the development of CCGs.
  • As co-commissioners, CCGs work with NHS England’s regional teams to ensure joined-up care.

Did you know?
NHS England directly commission highly specialised services. In some cases they also commission primary care, though most CCGs have now  taken on either full or joint responsibility alongside NHS England for this. 

What is the commissioning cycle?

The cycle can be broken down into four separate stages:

  • Analysing/assessing – finding out the healthcare needs of the local population and deciding how these needs can be met.
  • Planning – defining what services are needed to meet the needs of people, using data gathered at the analysis stage and designing care pathways for the delivery of care. This information is published in commissioning plans, which are essential reading for industry.
  • Securing – specifying what services are required, agreeing contracts with providers for the delivery of care and purchasing the services from either internal or external providers.
  • Monitoring – ongoing process of monitoring and evaluation of services to ensure that they meet the needs of the population, represent value for money and meet certain standards of quality. Commissioners are assessed on the quality of services they deliver, and if they do not meet certain standards of quality, could see reductions in the funding that they receive and have autonomy taken away from them.

Did you know?
As the healthcare needs of the population are always changing, the commissioning cycle typically takes place on an annual basis.

When is commissioning carried out?


Continually evaluate services to:

  • Actively manage current services.
  • Benchmark with peers.
  • Inform the planning of future services.


  • Collect and analyse population level data.
  • Demographics, prevalence and incidence of conditions.
  • Prioritise health needs of the population.
  • Consult with multiple stakeholders.


Create a vision for services:

  • The wishes and needs of the population.
  • Current services and performance.
  • Different population groups.
  • Opportunities for service transformation.


  • Agree contracts with providers, not based on activity.
  • Determine appropriate contract length and key outcomes.
  • Think of novel ways of contracting.

Source: NHS Clinical Commissioners

Commissioning – summary

  • Commissioning is about getting the best possible health outcomes for the local population.
  • This involves assessing local needs, deciding priorities and strategies, and then buying services on behalf of the population from providers such as hospitals, clinics, community health bodies, etc.
  • It is an ongoing process. Commissioning bodies must constantly respond and adapt to changing local circumstances.
  • They are responsible for the health and care of their entire population and are measured by how much they improve outcomes.

Did you know?
Commissioning is changing with the introduction of the NHS England new care models. Try to find out if your local health and care commissioners are using a new model.

What can I do with this information?

  • Before working with a customer/organisation, make sure you know where your customer’s organisations are in the commissioning cycle.
  • The best time to engage with commissioners is in the strategic planning phase, before spending decisions are taken.
  • Study the commissioning plans of the organisations that you work with, as they will outline the priorities of the organisations. Knowing this information will also demonstrate to your customers that you are interested in their work.

Did you know?
As of 1 April 2018, 178 CCGs have delegated commissioning arrangements for primary medical services. 



  • health economy, commissioners, commissioning, providers, purchasing, planning, analysing, securing, monitoring, care pathways, commissioning specifications.


Did you know?

  • Primary care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View. It gives CCGs an opportunity to take on greater responsibility for general practice commissioning.


This ends the course. You can now continue to the exam. 

Take Exam

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