Health National Commissioning Review
Improving National Health Service Commissioning Through Greater Alignment, Efficiency and Collaboration
Grosvenor partnered with Hunter New England and Central Coast Primary Health Network and the Department of Health and Aged Care to deliver a comprehensive review of national commissioning. This review examined processes across Australia’s 31 Primary Health Networks. Consequently, the national commissioning review identified opportunities to improve commissioning consistency, reduce duplication, strengthen collaboration, and design a future-state model. The aim was to improve efficiency while preserving regional flexibility and better health outcomes.
Situation
A total of 31 Primary Health Networks (PHNs) were established in 2015 by the Australian Government to better coordinate health services. They also aimed to improve the health outcomes of the people by commissioning health services. PHNs engage in commissioning, which is a process of planning, procuring and evaluating health services. In this process, they meet the priority health needs of people in their region. This context set the foundation for a broader national commissioning review.
In 2021, a governance and efficiency review of PHNs found four focus areas for improvement in PHN commissioning nationally:
› Sharing – of knowledge, content, benchmarking and systems
› Growing – through training and capability development and guidance documents
› Connecting – through communities of practice, events and newsletters
› Uniting – through submissions, responses, thought leadership and research.
To address these concerns, Hunter New England and Central Coast (HNECC) PHN CEO proposed undertaking an Australia-wide commissioning review at the national level. As part of the National Commissioning Review, the PHN Cooperative—a collective body including members from all 31 PHNs—endorsed further examination and improvement in commissioning. The HNECC PHN led this work on behalf of the PHN Cooperative and in partnership with the Department of Health and Aged Care (DoHAC).
Task
Grosvenor was engaged by HNECC PHN to deliver the National Commissioning Review project. In this national review of commissioning practices, the project sought to identify areas of duplication, variability and inefficiency in the current state, and identify opportunities to align commissioning practices and improve efficiency, consistency, effectiveness and user-centredness.
In undertaking this review, Grosvenor’s aimed to:
› gain a deep understanding of pain points for PHNs in the current state
› identify the future state aspirations of PHNs and appetite for alignment
› design alternative options for commissioning alignment
› assess and evaluate the options to identify the most appropriate model for PHNs.
Approach
A detailed methodology to deliver the project was agreed upon in close consultation with the PHN Cooperative. As part of an extensive national commissioning review, Grosvenor:
› designed fit-for-purpose data collection tools, with survey, document and data submission, and innovation case study collection being used. This helped to identify areas of duplication, inefficiency, innovation and better practice
› undertook a broad and high-level literature scan of publicly available information on commissioning approaches. In addition, they reviewed commissioning organisations
› held consultations with comparator organisations aimed at identifying alternative commissioning delivery models. They also focused on identifying lessons learned that can be applied in the PHN context
› engaged with PHN stakeholders through a Project Advisory Group, the data collection, and focus groups. This process helped to ascertain the current state and to inform recommendations for improvement
› identified options for improved consistency, efficiency and commissioning outcomes. This was defined given the primary health care and PHN context, strategic vision and better practice
› engaged with DoHAC to ensure their needs were identified. In addition, they ensured that the recommended option was feasible
› tested findings and insights, collected feedback. They also developed a final report including a cost analysis of the recommended option for the PHNs.
Given the high level of interest in this review among PHNs, the project was conducted in a transparent manner. This approach encouraged participation and input from PHN representatives and highlighted the wide engagement aspects central to a national commissioning review process.
Result
Grosvenor identified five options to align the commissioning approach across PHNs. Using four design criteria, risk considerations and feedback received from the DoHAC and PHN representatives, one option was shortlisted as the preferred option. This option had the potential for the greatest improvement gains while maintaining the regional flexibility of PHNs to deal with local circumstances. It also enabled a focus on priority initiatives through Communities of Practice and supported a culture of sharing and collaboration. These outcomes are significant results achieved through national commissioning review activities. A set of 11 recommendations were identified to implement the preferred option using a three-step glide path encompassing planning for implementation, implementation and transition to future state and ongoing review and improvement.