Key points

  • Policy makers need a long-term plan to nurture outcomes-based commissioning to enable it to support the transformation of health care.
  • Outcomes-based commissioning seeks to solve the issue of how financial flows and the commissioning process can best support quality and efficiency improves across the health care system.
  • Outcomes-based commissioning shows promise as a means to help transform health care, but evidence to support it is limited and it is proving harder to implement than foreseen. Careful learning and significant support is needed to help it live up to its potential.
  • Outcomes-based commissioning needs long-term support from policy makers, including NHS England to support the capability of commissioners, and the future NHS Improvement to help develop providers’ ability to respond, particularly in primary care.
  • There needs to be far greater peer-to-peer learning between areas experimenting with the approach. This should include the development of a ‘learning network’ to connect and share knowledge not only from the NHS, but also from areas internationally and other parts of the public sector.

Need to nurture: outcomes-based commissioning in the NHS examines what outcomes-based commissioning means, the evidence to support it, progress to date on introducing the approach in England, and the optimum role of national policy in response to it. 

This work is the product of interviews and discussions with many commissioners, providers, policy makers, experts and academics; as well as a rapid literature review. 

Although the first scheme only started in 2011, there is now rapid expansion of outcomes-based commissioning across England. The following map shows details of outcomes-based commissioning contracts in England that have already been awarded, or are being planned. This is not an exhaustive list and there are many other areas that are planning to introduce the approach. 

Key - contracts awarded

  • red flag - 2011
  • yellow flag - 2013
  • pink flag - 2014
  • green flag - 2015
  • blue flag - planned
  • purple flag - delayed or postponed

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