Collaborative Commissioning events

The journey –

From 2008 to 2009, two acute trusts in NHS South West took part in the Orthopaedic Rapid Improvement Programme led by the NHS Institute. Interest in the programme was much more widespread than this: another 15 acute trusts in the region applied to the programme but were not selected as pilot sites. As a result, the SHA decided to work with the NHS Institute to spread the learning from the Orthopaedic Rapid Improvement Programme, in particular from the two pilots in the region, and build on the desire for improvement.

For these reasons, the SHA and NHS Institute designed a programme of three events focused on good practice in the commissioning and delivery of orthopaedic surgery. They brought together commissioners, nurses, managers, physiotherapists, surgeons and anaesthetists to build relationships and common understanding of best practice, and foster a more collaborative culture.



The Collaborative Commissioning events were seen to create more conversation, networking and collaboration across organisational and professional boundaries – for example, service providers started working with their commissioners to solve issues; and teams from local trusts worked alongside independent sector treatment centres.

Following the events, improvements were also seen in about a third of the elements of the pathways. The divergence between the best and worst providers initially increased, suggesting that the better ones responded faster to put learning from the events into practice, but performance has since converged. The region is now estimated to be saving about 250 to 280 beds a year for orthopaedic pathways, compared to a national average of about 50.


Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems


Clinical area

Staying healthy Maternity and newborn Children and young people Acute care X
Planned care  X Mental health Long-term conditions End of life


Information, tools and techniques used

In designing the programme of events, the SHA was aware (not least from the Darzi white paper) that a particular challenge to address was a lack of collaboration and common understanding in the commissioning process. The events were themselves developed collaboratively. They were workshop based and open to the 14 PCTs and all providers of fractured neck of femur and hip and knee surgery (including the independent sector) in the south west.



Across the south west of England



Over a period of six months from spring 2009.


Contact details and further information

Sasha Karakusevic led the design of the events; Deborah Thompson headed the orthopaedic Rapid Improvement Programme team.

Posted on Jan 16th, Cat: , , , Tags: , Comments: Comments are off for this post

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