A call for action: improving decision-making in the commissioning of health services

Jones, S. & Turner, A. BMJ Clinical Evidence Blog. Published online: 27 October 2016


While evidence based medicine (EBM) has been promoted for over 20 years and has influenced other disciplines like nursing, little attention has been paid to decision-making in NHS clinical commissioning: the planning and purchasing of services to meet the healthcare needs of the local population. Where EBM supports clinical decisions on an individual patient basis, there is no equivalent philosophy for commissioning, where decisions are made that can affect hundreds of thousands of people.

The way commissioners access and use evidence is highly variable: the commissioning setting lacks the scientific framework that is present in medicine. Increasing integration means commissioners come from a range of backgrounds with varying skills and experience relating to evidence utilisation. What is meant by evidence in this setting is ill-defined: commissioners use different kinds of ‘evidence’ including data, best practice guidelines, research findings and patient feedback. Research evidence is not always available, of varying quality and often lacks actionable insights to inform decision making. Where these gaps exist, commissioners themselves could contribute but there is no consistent process by which the evidence base can be improved through evaluation findings or co-produced research.

Read the full blog post here



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