Objective We explored what constitutes successful commissioning for transition and what challenges are associated with this. We aimed: (1) to identify explicit and implicit organisational structures, processes and relationships that drive commissioning around transition; (2) to identify challenges faced by commissioners; and (3) to develop a conceptual model.
Design A qualitative interview study.
Setting Commissioning and provider organisations across primary and secondary care and third sector in England, UK.
Participants Representatives (n=14) from clinical commissioning groups, health and well-being boards and local authorities that commission national health services (NHS) for transition from children’s to adults’ services in England; NHS directors, general practitioners and senior clinicians (n=9); and frontline NHS and third sector providers (n=6).
Results Both commissioners and providers thought successful transition is personalised, coordinated and collaborative with a focus on broad life outcomes and actualised through building pathways and universal services. A multitude of challenges were described, including inconsistent national guidance, fragmented resources, incompatible local processes, lack of clear outcomes and professional roles and relationships. No single specific process of commissioning for transition emerged—instead complex, multi-layered, interactive processes were described.
Conclusions The findings indicate a need to consider more explicitly the impact of national policies and funding streams on commissioning for transition. Commissioners need to require care pathways that enable integrated provision for this population and seek ways to ensure that generalist community providers engage with children with long-term conditions from early on. Future research is needed to identify a core set of specific, meaningful transition outcomes that can be commissioned, measured and monitored.
- health services research
- health economics
- general paediatrics
- qualitative research
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Contributors AC contributed to the study design, data analysis and the writing of the initial report and the subsequent manuscript (especially the introduction, discussion and the reviews of the literature); and approved the final version of the manuscript. ALC contributed to the study design, data analysis and the writing of the initial report and the manuscript (especially discussion); and approved the final version of the manuscript. GM contributed to the data analysis and writing of the initial report (especially the results) and approved the final version of the manuscript. LV contributed to the overall design, the writing of the initial report and the subsequent manuscript (especially methods) and approved the final version of the manuscript. NK contributed to the study design, data collection plan and data analysis; led the writing of the initial report and the subsequent manuscript; and approved the final version of the manuscript. SMC led the review of all the literature and the development of the data collection plan and materials, collected the data and contributed to the data analysis; co-led the writing of the manuscript; and approved the final version of the manuscript.
Competing interests None declared.
Ethics approval Newcastle University Faculty of Medical Sciences Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data are not shared through a public repository as this was not part of the initial consent, and after careful consideration, anonymising it for public sharing is not considered feasible. Researchers interested in accessing the data should contact the authors directly to discuss access arrangements.
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