W1 - Commissioning and competition

Question 1

When was the internal market introduced and implemented within NHS?

Answer 1

1991-7

Question 2

Features of NHS internal market

Answer 2

• Split of purchaser and provider
• Both private and public hospitals competing to win contracts
• Hospitals now trusts regulated by DH rather than HAs
• GP fundholding

Question 3

Explain the provider split + changes to commissioner names

Answer 3

• Providers are commissioners
• Assess needs of public, funding goes to which services?
• Primary care trusts -> clinical commissioning groups -> ICSs (2022)

Question 4

Explain the purchasers split
- introduction of NHS trusts

Answer 4

• Purchasers deliver health services
• NHS hospitals + trusts, GPs, private hospitals, independent treatment centres
• Labour introduced NHS trusts -> high performing given financial autonomy by retaining surpluses (incentive)

Question 5

Downfalls of Conservative internal market

Answer 5

• Experimental -> little structure and regulatory oversight
• No retainment of surpluses for trusts gave little incentive to grow market share

Question 6

Describe the changes in the second era of hospital competition - New Labour (5 bullet points)

Answer 6

• Expansion of competing providers -> NHS trusts, private providers, independent treatment centres, foundation trusts.
• Financial autonomy for foundation trusts
• 5% annual funding increases
• Patient choice (2006) - public online metrics
• DH price regulation = competing on quality NOT price

Question 7

Motivations behind introduction of the payment/provider split? (3 bullet points)

Answer 7

• Increase accountability
• Purchasers independently assess provider performance
• Increase competition and choice = attract more contracts

Question 8

Did New Labour abolish pro market policies?

Answer 8

NO, the label of internal market label was abolished but pro market policies maintained the P/P split

Question 9

How and when was the purchaser/provider split abandoned?
- Key driver publication, features?

Answer 9

-In favour of current structures favouring collaboration and integration such as 2022 ICSs
- 2014 5 year forward report by NHS England -> rejected pro comp, called for wide scale integration of leadership

Question 10

What are Integrated Care Systems (ICSs)
- Who is involved + what are their 3 key roles?

Answer 10

• Commissioners and NHS service providers in partnership with LAs and others
  -Take responsibility for resource management, delivering NHS standards, improving population health