Commissioning is a knowledge industry which can be done well, but not profitably

Treacy and Wiersema’s research into how US companies converted knowledge into profit identified three “value disciplines” of Customer Intimacy, Product Leadership and Operational Excellence.  The research showed that to be profitable, enterprises are obliged to focus on one of these disciplines, adding value by trade offs between quality, price and convenience.

The three value disciplines translate well into the high level knowledge requirements for commissioners of health and care services:

  • Customer Intimacy: Intimate knowledge of health needs including, crucially, soft intelligence / insight into local patterns of behaviour and the dynamics of interactions between users and services.
  • Product Leadership: Securing value for money requires leading edge knowledge of how quality services can be provided efficiently – understanding your providers’ business at least as well as they do.
  • Operational Excellence: Comprehensive knowledge of all the elements of the commissioning process and their inter-relationships, and gathering, processing and acting on real-time intelligence about performance and inter-actions between players in the local health system.

NHS – and the public – needs all of these to be done well, and in an integrated fashion. You can’t just do one part of commissioning, and not do the rest because it’s not profitable. People’s lives and health, and billions of public money are at stake.

The new Clinical Commissioning Groups are essentially committees of time-poor GPs, supported by some hard-pressed Jacks and Jills of all trades.  Private healthcare corporations are gearing up their cherry-picking machinery. The remnants of PCTs are quietly being boiled down to 20-30 Commissioning Support Organisations, who will become trading enterprises.

How will these arrangements meet the challenge of informing commissioning decisions in the very large and complex system that is the NHS ? How do they get the holistic integration of hard and soft intelligence across the value disciplines ? How will they get down into the detail where the devils are – specialisms, localities, and the thorny thickets of integrating services ? How will they even know what they are missing ?


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