The impact of the commissioning agenda upon nursing practice: a proactive approach to influencing health policy.

The commissioning aspect of purchasing, in the context of health care, has been heralded as an activity that will effect a shift towards a health service. According to the Department of Health (DoH), England, it will be a key factor in ensuring the ideals of the reforms; i.e. efficiency, equity and effectiveness move from being rhetoric to reality. The importance being placed upon commissioning has implications for the functioning of each professional group. Nursing has historically been identified as relatively naive in matters outside the immediate province of patient care and has suffered from a lack of any real influence in the health policy arena. This paper attempts to describe the impact that the current emphasis on commissioning will have on nursing practice and proposes that unless nurses understand and engage in debate around the purchasing and commissioning function in health care, nursing's capacity to influence the future development of patient services will be severely limited. A framework is outlined for addressing this, thereby ensuring that nursing can proactively inform present and future commissioning agendas.