About the author

I have been a commissioner in the NHS since 2009. I previously worked as an allied health professional on the frontline in neurophysiology, but I enjoyed the planning and designing side of work more than the practical hands- on aspects. I had a friend who worked in NHS commissioning, and it sounded like an interesting job and a better fit for me. A vacancy came up in a neighbouring town, but I had zero commissioning experience. However, I did my research and, luckily, the two people who interviewed me believed that enthusiasm can equal potential. The rest is history: I spent nine years in local commissioning within a clinical commissioning group and then five years in national commissioning for NHS England. I now work on an independent basis alongside many commissioning organisations. This has enabled me to learn more, spread my expertise, and be actively involved in supporting a greater number of improvements for health and social care.

Back in 2009, the clinical commissioning group I worked in was small. We had a limited team due to the small population in the area, and everybody had to cover a wide breadth of responsibilities. It was a very busy and at times hectic approach, but it gave me valuable exposure to every sector of care (acute, community, primary, voluntary, independent, and social care) and experience across multiple roles (analysis, transformation, contract negotiation, finance, quality, and so on). This meant I had the knowledge, skills, and confidence to tackle just about any commissioning problem.

In my NHS England role, I soon realised that the level of knowledge of end- to- end commissioning processes I had gained was not necessarily shared by all commissioners. The commissioners I met, especially those in larger organisations, had a specific responsibility within a particular sector of health and care. They would know their specialist area – for example, improving cancer services – inside out, but often had not had the chance to gain experience in all aspects of commissioning. For instance, they may not have in- depth knowledge of preparing a contract – they would have a separate team to complete tasks like that for them. However, this piecemeal approach to commissioning can create issues where the different commissioning functions don't have a clear understanding of how they can support each other to best effect.