Commissioning consultants

The NHS uses an increasing number of commercial and not-for-profit management consultancies in healthcare commissioning but there are concerns about whether knowledge and expertise they generate is of benefit to commissioners and whether it improves the quality of commissioning.

In the largest study of its kind in the UK, researchers from the Universities of Bristol and Southampton have for the first time observed this processes of knowledge exchange and assessed the perceived impact on commissioning decisions. The findings are published today in the journal BMJ Open.

The researchers analysed eight case studies between external providers and commissioning organisations which encompassed four contracts worth a total of £30 million. They found that external providers were only partly successful in improving the perceived quality of commissioning, largely because the knowledge exchange interactions between external providers and NHS clients were limited.

Dr Lesley Wye, research fellow at the University of Bristol’s Centre for Academic Primary Care, said: “Of the four contracts we analysed, two contracts had limited value, one had short-term benefits and one provided short and longer-term benefits. Without explicit mechanisms in contracts whereby NHS clients and management consultants ensure that local healthcare staff have enough time to learn new skills, including ways to interpret and apply the information locally, the value of these expensive contracts with management consultancies is severely reduced and NHS clients can end up dependent long-term. This can lead to a monopoly relationship which may actually be more expensive for the NHS in the long run.”

Dr Wye and her colleagues were given unprecedented access to three consultancies that offered software tools for analytics and project management. Two were commercial providers and one was a not-for-profit agency. The researchers conducted 92 interviews with management consultants, their clients and others; observed 25 training events and meetings; and analysed documents and reports.

They found that the external providers offered commissioners three different types of service:

• technical transfer (e.g. software tool training, operation and application)
• expertise (e.g. knowledge and skills in project management and analytics)
• outsourcing (e.g. taking over commissioning teams/ units wholesale)

External providers were also engaged for their ‘big picture’ perspective; potential to challenge local stakeholders; knowledge from international and national sources; and new approaches to recurrent problems. The researchers found that the consultancies only had limited success in achieving these aims.

In a report published today the researchers make a number of recommendations that they hope will improve the knowledge transfer from external providers to commissioners.

“If looking to procure external software or other technical based tools to help inform commissioning, commissioners need to be really clear on what their expectations of the tool are and what the problem is that they are trying to solve. Otherwise they are unlikely to procure the right solution,” said Dr Wye. “And external providers of such solutions need to provide interpreters who can help commissioners to understand and use the data outputs in ways that are helpful to them. Commissioners need to think about this when procuring.”