The challenges of commissioning healthcare: a discussion paper.

The UK's Department of Health Independent Sector Programme to procure healthcare for National Health Service (NHS) patients from the independent sector revealed many of the challenges of commissioning, particularly assessing governance arrangements and identifying the organisational attributes of high quality healthcare providers. These issues were first discussed in a workshop at the British Association of Medical Managers (BAMM) Medical Directors Conference in Dublin in November 2007 (Dale, et al., 2009). The more difficult challenges of achieving effective clinical engagement, including motivational factors, organisational environment and systems and partnership working, in the complex field of commissioning healthcare in the UK are also explored here with particular reference to systems in other countries.