Payment, power and the commissioning of health services

Arrival: 12pm Seminar: 12.15pm - 1.15pm.

Tea, coffee and sandwiches provided (please register if you want these, and to guarantee a seat!)


Rod Sheaff, Professor in Health Services Research, Plymouth School of Government (Faculty of Business)


Our mixed-methods realistic evaluation sought to understand how NHS commissioners can exercise governance over service providers.

We also examined:

  • the consequences of shifting from commissioning for a geographically defined population to client-based commissioning, where the patient (or her GP) selects a care provider, who is paid per episode of service, optionally from a budget held by the client herself

  • how commissioning differs for specific care groups (e.g. orthopaedics, mental health)

  • what contextual factors influence commissioners' governance over providers

Main findings

  • NHS commissioning practice differed in certain respects from what policy makers had assumed.

  • Where multiple hospitals 'competed', analysis suggested that some of their service outcomes improved, but more did not.

  • Each commissioning structure appears to engenders a characteristic mode of commissioning.

  • A client-based tariff system of paying providers (e.g. DRG, HRG) weakens commissioners’ governance over providers

  • Commissioners influenced providers in a variety of ways, including managerial techniques; a negotiated order (including 'micro-commissioning'), the evidence-basing of clinical practice; shared ideological assumptions (whose content varied considerably between countries); and by adjusting incentives

About Rod Sheaff

My research interests focus on the over-arching question:

What are the relationships between organisational structures, production processes and policy outcomes in the health sector, and in public sector and 'third sector' organisations more widely?

Current and recent research projects include:

  • Integration and Continuity in Primary Care: Polyclinics and Alternatives, for NIHR Health Services and Delivery R&D Programme.

  • NHS Commissioning Practice and Health System Governance, for NIHR Health Services and Delivery R&D Programme.

  • The management and effectiveness of professional and clinical networks, for NHS Service Delivery and Organisation R&D Programme.

  • Factors associated with clinical focus in NHS Trust Boards. Burdett Trust.


  • free
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