Date: 10 April 2017
I have always been of the mindset that to be the best commissioner I can, I need to use the best available evidence, information and best practice from across the country and abroad. But I am not sure I am typical as a commissioner. As commissioners we are influenced by a vast range of competing factors. Some of these are:
Research evidence is one of these factors, of which I value highly, but it doesn’t always help us out as commissioners. RCTs are not often applicable to pockets of our population. In addition research often doesn’t answer specific problems, e.g. is it possible to expand the patient cohort and get positive results for a population? Research often offers answers for healthcare providers and clinicians easier than commissioners, as it is more black and white – is drug A better than drug B? As commissioners, we have thornier issues, such as what one or two interventions are going to make the greatest impact for the population we serve? Is it affordable? How do we implement it effectively?
Another factor which often is overlooked by researchers is implementation which is complex even when the research evidence is clear. An example of this would be anticoagulation for patients with Atrial Fibrillation to prevent stroke. Despite knowing we should make this happen as commissioners, the research doesn’t help us overcome some of the practical hurdles to make it happen because:
In summary, our job as commissioners is to change systems (many and varied) to improve care - despite being up against people’s views and beliefs, payment systems, competing priorities and time pressure. I firmly believe that research evidence, although not perfect, can help us make better decisions. I would also, however, implore researchers to come and talk to us, to understand our pressures, our areas of worry, and help us build research evidence that answers our commissioning questions, with us.
For more information about the working world of commissioners, please see ‘evidence-based policy-making and the art of commissioning’ - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1091-x
Rachel Anthwal, Delivery Director at Bristol CCG, discusses using research evidence in commissioning decisions and the challenges of doing so.
Delivery Director, Bristol Clinical Commissioning Group