title: Governance for health and wellbeing in the English NHS.
abstract: OBJECTIVE
  Shifting the focus of health-care systems towards prevention has proved difficult to achieve. Governance structures are complex, incentives may conflict and there are many competing priorities. We explored the influence of governance and incentive arrangements on commissioning for health and well-being in the English National Health Service (NHS) and the governance paradoxes which emerge.
  
  
  METHODS
  Qualitative and quantitative methods were employed. We carried out one national and two regional focus groups; a national online survey of primary care trusts (PCTs); and 99 semi-structured interviews in 10 purposively selected case study sites across England. Interviewees included decision-makers in PCTs, practice-based commissioners, Chairs of Local Involvement Networks (LINks) and of Overview and Scrutiny committees (OSCs) and Voluntary and Community Sector (VCS) members of local health and wellbeing partnerships.
  
  
  RESULTS
  Case study sites differed in the extent to which they reflected a public health ethos throughout the commissioning cycle, incentivized preventive services through contractual flexibilities or prioritized investment in health and wellbeing. Practice-based commissioners were tangentially involved in the commissioning cycle, public health partnerships or local health needs assessment. While commissioning for health and wellbeing involves working through partnerships, performance management regimes favoured single organizational success. Preventive services were considered at increased risk in times of financial stringency.
  
  
  CONCLUSIONS
  As the NHS in England undergoes further reorganization, it is important to ensure that a systematic, strategic and population-based approach to commissioning is not lost. Governance and incentive arrangements should be critically assessed for their impact on population health and wellbeing.
authors: Centre for Public Policy and Health, School of Medicine and Health, Wolfson Research Institute, Durham University Queen's Campus, Stockton-on-Tees, UK. Linda.Marks@durham.ac.uk
authors: Linda
authors: L
authors: Marks
authors: Sally
authors: S
authors: Cave
authors: David
authors: D
authors: Hunter
authors: James
authors: J
authors: Mason
authors: Stephen
authors: S
authors: Peckham
authors: Andrew
authors: A
authors: Wallace
mesh_terms: D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D017144:Focus Groups; D006075:Governing Board; D006291:Health Policy; D006801:Humans; D009042:Motivation; D019982:Organizational Case Studies; D011315:Preventive Medicine / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D011788:Quality of Life; D013222:State Medicine / Q000458:organization & administration*