title: Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes.
abstract: To explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need.
  
  
  
  A multisite, quasi-ethnographic exploration of 9 CCGs.
  
  
  
  National Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas.
  
  
  
  Content analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30 hours).
  
  
  
  Observations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services ('person-centred', whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.
  
  
  
  Commissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic planning of lay involvement to provide an avenue for genuine engagement, so that support can be provided for communities and individuals in a way people will engage with.
authors.affiliation: Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Reidy
authors.affiliation: Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pope
authors.affiliation: Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
authors.forename: Claire
authors.identifier: 0000-0002-3647-7631
authors.initials: C
authors.lastname: Ballinger
authors.affiliation: Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
authors.forename: Ivo
authors.initials: I
authors.lastname: Vassilev
authors.affiliation: Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D026683:Advisory Committees / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D004739:England; D018166:Health Care Reform / Q000458:organization & administration; D006285:Health Planning / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D000073278:Self-Management; D013222:State Medicine / Q000458:organization & administration
keywords: Commissioning; Ethnography; Health services research; Self-management support