More needs to be done to develop and support the organisations responsible for spending 80% of the NHS budget, and to engage citizens in making decisions about local healthcare, according to two new reports produced by the University of Birmingham’s Health Services Management Centre.

Recent changes in government policy have marked a shift towards an NHS that is more locally focused, with fewer central government targets, and more choice for individual patients.

Primary Care Trusts are the key representative of the NHS at a local level, making decisions about local priorities in healthcare, and commissioning health services on behalf of the communities they serve.

“Towards World Class Commissioning Competency” (a report produced for the West Midlands Strategic Health Authority) identifies some of the greatest challenges facing commissioners of local health services, and the skills they need to tackle them.

These include creative public health expertise, in particular engaging people in improving their own health and the overall health of the local population in order to reduce the demands on the healthcare system, and finding ways to involve local people in priority-setting and decision-making.

The report welcomes the Department of Health’s recently published vision for ‘World Class Commissioning’ in the NHS, but highlights some key issues which have not been fully addressed. 

The authors stress that there is currently very little evidence to demonstrate how commissioners can best influence healthcare providers, and use the commissioning process to achieve improvements in the health of the population.  

Professor Chris Ham comments: “While it is encouraging to see the government providing a framework to help commissioners understand and develop their role, there must also be an understanding that it will take time to build up our knowledge of what approaches work best. Commissioning is just one part of the health system, and its success must always be seen as part of wider investment and regulation in the system as a whole.”

The second paper “How can PCTs shape, reflect and increase public value?” looks at how Primary Care Trusts can help deliver a more responsive, ‘patient-led’ NHS 

‘Public value’ is the contribution that public services make to communities and society.

This paper argues that Primary Care Trusts are currently not doing enough to engage local people in the decisions they make about local health care priorities, and to explain how those decisions contribute to increasing public value.

Lead author Dr Iestyn Williams comments: “If the issues surrounding Herceptin showed anything it is that PCT’s are not always in touch with their communities and communities are often unaware of the reasoning behind PCT decisions. In the current context where the work of NHS managers is under greater scrutiny, it has become increasingly important that primary care trusts can demonstrate that their decision making process is transparent and accountable to the wider public.

Organisations like the BBC are increasingly being asked to demonstrate that their services provide value to the public. This ‘public value test’ could and should be applied by Primary Care Trusts. Although PCTs are starting to make the right moves there is still more that should be done to involve clinicians in explaining decisions and in making sure the process involved is clear and open to public scrutiny.”


 For further information or to request a copy of the reports contact Ben Hill, Press Officer, University of Birmingham, Tel 0121 4145134, Mob 07789 921 163


The reports “Towards World Class Commissioning Competency” (Juliet Woodin and Elizabeth Wade) and “How can PCTs shape, reflect and increase public value?” (Iestyn Williams, Helen Dickinson, Elizabeth Wade, Joan Durose and Edward Peck) are available on the Health Services Management Centre website.


The Health Services Management Centre is one of the leading centres specialising in development, education and research in health and social care services in the UK. HSMC’s prime purpose is to strengthen the management and leadership of these services and to promote improved health and well-being.

HSMC currently has a wide range of research grants from major research funders such as the Department of Health Policy Research Programme and the National Institute for Clinical Excellence and undertakes regular research and evaluation work for Primary Care Trusts, Care Trusts, NHS Trusts and Local Authorities.

HSMC runs a number of MSc programmes including Health Care Policy and Management and co-directs a new MSc in Public Service Commissioning with its sister department, the Institute for Local Government Studies.  These programmes emphasise the application of theoretical perspectives to current policy and practice in the NHS and other health care systems, and are explicitly designed to support professional as well as academic development.