Commissioning

Public health professionals make a significant contribution to commissioning, particularly in the interpretation of evidence and the preparation of specifications for preventive, diagnostic, treatment and care services. However, at present:

• there is significant unknowing duplication of effort �" for example, the majority of the 152 PCTs are commissioning rheumatoid arthritis services;
• there is a significant mismatch between commissioner knowledge and credibility and clinician/provider knowledge and credibility, because the majority of PCTs are currently commissioning services individually for rheumatoid arthritis, inflammatory bowel disease, and every other type of service, apart from those commissioned by specialist commissioning services;
• there is very little sharing of expertise or experience �" about half of the PCTs are involved in a Yahoo group �" but the number of PCTs where public health professionals make an active contribution is very small;
• each public health professional and team may have to face up to heavy pressure from clinicians, providers, patients, and, sometimes, politicians; even when clear guidance is available, for example from NICE, it may not be in a form useful to commissioners, with the exception of that small proportion of guidance specifically for commissioners, and as a consequence the guidance has to be adapted for commissioners; in most parts of the country, this is done by every PCT;
• public health professionals feel under considerable pressure.