The Intelligent Commissioning Board. The programme of NHS reform focuses on more choice and stronger voice for patients, plurality of provision, money following the patient and a stronger regulatory and accountability framework with strong commissioning the cornerstone of system reforms. There are a number of challenges presented by this: In a market with multiple providers, the balance between managed commissioning and a system driven more by incentives and choice ; • Managing Payment by Results in a resource limited environment and what levers commissioners will have in managing demand and maintaining financial balance; The potential conflict between patient choice and sufficient capacity to ensure the achievement of national targets i.e. 18 week wait; • Clarifying accountability and contracting arrangements for GPs acting as commissioners and providers; Building skills and capacities to deliver effective commissioning ensuring there is a clear distinction between their functions as commissioners and providers; Developing new models of stakeholder engagement, ensuring meaningful dialogue with patients and the public to understand health needs and support decisions on commissioning and service configuration. Organisations will need to ensure that services are commissioned from a range of new and existing provider organisations. A transparent process for awarding contracts will need to be established with providers competing on a fair and equitable basis. Providers will be held to account for delivery against contracts including activity, quality and financial measures. Clear governance arrangements will need to be established to distinguish provider/commissioner functions i.e. within line management and accountability arrangement within the operation of the governance arrangements of the organisation.
