World-class commissioning competency (Completed 2008)


The review was undertaken for the West Midlands Strategic Health Authority, it set out to consider questions such as:

  • What are health care commissioners required to do?
  • What knowledge, skills, attitudes and behaviours are required to do it well?
  • Who (either within or beyond the NHS) is most likely to possess these attributes at the moment?
  • How should these capabilities be developed and distributed in future?


The paper considers the overarching objectives of the UK healthcare system, and the ways in which commissioning was originally intended to contribute to the achievement of these objectives. It also reviews a number of existing frameworks that have been produced to describe the activities of commissioners (in the NHS and in other sectors), and the competencies that commentators believe to be required to perform these tasks effectively. From this, fourteen domains of competency for ‘world class’ commissioning are identified.

The paper emphasizes that existing evidence tells us little about the specific mechanisms through which commissioning competency does, or does not, lead to improved health system outcomes. It concludes that a one-size-fits-all approach to defining and developing commissioning competency is unlikely to be optimal, and reiterates that competency depends not just on knowledge and skills, but on values, motivation, and agency.

Towards World Class Commissioning Competency Report (PDF)

As part of this project, Chris Ham reviewed the evidence on international experience of health care commissioning.

Health Care Commissioning in the International Context: Lessons for experience and evidence (PDF)

Date: 2007
Researchers: Juliet Woodin and Elizabeth Wade
Funder: West Midlands Strategic Health Authority

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