Commissioning specific programmes

The next step would be for NHS commissioners to translate these into a set of commissioning intentions for when the time comes to re-tender programmes. Just as an example, the London HIV Consortium, through its Pan-London HIV Prevention programme, issued a set of Commissioning Intentions in mid-2007 in which it proposed changes to HIV prevention in London.

These included a new African Communities HIV Prevention Programme, a move in gay men’s prevention programmes towards more in-depth ‘one to one structured interventions’, as described in the NICE guidance,  and a new arm of the programme directed at preventing onward transmission and promoting good sexual health in people with HIV. This proposed devising a new type of support worker called an HIV Health Trainer.

The commissioners were explicit that their intentions were based on the literature on the evidence of efficacy: “Outcomes-focussed commissioning means that, in addition to measuring outputs, commissioners are seeking to commission interventions according to what results are to be achieved rather than what activities will be conducted. For example, how many people saw an increase in positive behaviour change and less risk taking as a result of sexual health counselling (outcomes) rather than how many people completed a course of counselling (outputs) or how many counselling sessions were provided (input)” [italics in original].

They added: “Commissioners recognise the difficulties of measuring what does not happen (e.g. the transmission of HIV) and recognise that there may be some circumstances in which the difficulties of measuring outcomes are so great that it is only possible to measure outputs, but will work with providers to develop more outcome-focussed measures over the period of the contract.”