Commissioning is the process by which health and care services are planned, purchased and monitored.

Commissioning comprises a range of activities, including:

  • assessing needs
  • planning services
  • procuring services
  • monitoring quality

The process, which is repeated typically on an annual basis, is often shown as a cycle:

The Commissioning Cycle

CCG Commissioning Responsibilities

CCGs have a statutory responsibility for commissioning most NHS services including urgent and emergency care, acute care, mental health and community services. Increasingly CCGs are also involved in commissioning primary care and some specialised services.

Since 2013, local authorities have been responsible for commissioning public health services including, for example, sexual health services, health visitors, school nursing and addiction services.

Primary Care Co-Commissioning

The NHS Five Year Forward View (2014) set out the government’s aim to give CCGs more influence over the NHS budget. This is in order to support the development of integrated services designed to meet the needs of the local population.

NWS CCG now has a fully delegated role in commissioning general practice (GP) services through a co-commissioning agreement with NHS England. 

Further information about Primary Care Co-Commissioning can be found on NHS England's website

CCGs and local authorities 

NWS CCG works closely with Surrey County Council to support more integrated health and social care arrangements for our local population. This is achieved by way of The Better Care Fund, a national programme, designed to support integrated care and requires CCGs and local authorities to work together by pooling budgets. 

 New care models and Accountable Care Systems

Since 2014, commissioners and providers have been working together to develop new care models which bring together local NHS organisations to provide a range of services and deliver more integrated care for patients. 

Some areas are now developing Accountable Care Systems (ACSs) and Accountable Care Organisations (ACOs) which may involve providers and commissioners working together in a different way. These models are still being developed but it is likely that in most cases commissioners will contract with a single organisation or partnership of organisations to manage a single budget and deliver a range of services for the local population, focusing on the population’s health and wellbeing.

  • An alliance of providers that collaborate to meet the needs of a defined population.
  • An alliance of providers taking on responsibility for one budget allocated by a commissioner or alliance of commissioners to deliver a range of services for that population.
  • An alliance of providers working under a contract that specifies the outcomes and other objectives they are required to achieve within the given budget, often extending over a number of years.

It is likely that under this model commissioners will take on a more strategic role in overseeing the local health system, focusing more on overall performance and less on individual services.

You can find further information on NHS England's website


In Greater Manchester, CCGs, local authorities and other local bodies have come together to take responsibility for the entire local health and care budget. This arrangement is supported by new governance structures including a Greater Manchester Health and Social Care Strategic Partnership Board and a joint commissioning board.

The Surrey Heartlands area, of which North West Surrey CCG is a partner along with Guildford & Waverley CCG, Surrey Downs CCG and other health and social organisations, has also agreed a devolution deal due to be implemented in early 2018, which will be similar to that agreed for Greater Manchester.

More information about Surrey Heartlands Partnership can be found on our Surrey Heartlands Partnership page