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Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Maniatopoulos, Gregory, Haining, Shona and Wilkes, Scott (2019) Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care. BMC Health Services Research, 19 (648). ISSN 1472-6963

Item Type: Article


Commissioning innovative health technologies is typically complex and multi-faceted. Drawing on the negotiated order perspective, we explore the process by which commissioning organisations make their decisions to commission innovative health technologies. The empirical backdrop to this discussion is provided by a case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. Methods: The research involved an empirical case study of four Clinical Commissioning Groups (CCGs) involved in the commissioning of services in primary and secondary care. Semi-structured in-depth interviews (16 in total) and two focus groups (a total of eight people participated, four in each group) were conducted with key individuals involved in commissioning services in the NHS including (i) senior NHS clinical leaders and directors (ii) commissioners and health care managers across CCGs and (iii) local general practitioners.

Commissioning of a new diagnostic technology for peripheral arterial disease in primary care involves high levels of protracted negotiations over funding between providers and commissioners, alliance building, conflict resolution and compromise of objectives where the outcomes of change are highly contingent upon interventions made across different care settings. Our evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations.

Innovative health technologies such as the diagnostic technology for peripheral arterial disease are commissioned in care pathways where the value of such technology is realised by those delivering care to patients. The detail of how care pathways are commissioned is complex and involves high degrees of uncertainty concerning such issues as prioritisation decisions, patient benefits, clinical buy-in, value for money and unintended consequences. Recent developments in the new care models and integrated care systems (ICSs) in the UK offer a unique opportunity for the successful commissioning arrangements of innovative health technologies in primary care such as the new diagnostic technology for peripheral arterial disease.

Keywords: Commissioning, Decision-making, Diagnostics, Innovative health technologies, Primary care, Peripheral
arterial disease, United Kingdom

2019 BMC Health Services Research NOTEPAD .pdf - Published Version
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Depositing User: Tracy Skipper


Item ID: 11167
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ISSN: 1472-6963
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ORCID for Scott Wilkes: ORCID iD

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Date Deposited: 03 Oct 2019 08:25
Last Modified: 20 Jan 2023 10:08


Author: Scott Wilkes ORCID iD
Author: Gregory Maniatopoulos
Author: Shona Haining

University Divisions

Faculty of Health Sciences and Wellbeing


Sciences > Health Sciences

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