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Independents' Day

Five-minute guide to…designing a new service

The fourth of our eight-part guide on the basics of PBC, produced by Beverley Slater and Michelle Webster of the Improvement Foundation.

The fourth of our eight-part guide on the basics of PBC, produced by Beverley Slater and Michelle Webster of the Improvement Foundation.

Official definition

Practices working individually or in groups to develop models to improve healthcare services and address the public's priorities

Put into layman's terms

Changing services so they meet the needs of patients better

What it involves

1 Process-mapping the current service to identify what could be improved
2 Learning about other successful models
3 Working with clinicians across the service pathway to develop a better service model
4 Developing a business case for the PCT

Important because…

Poorly designed services provide suboptimal care and waste NHS resources

How to go about it

Having assessed needs, reviewed current service provision and decided priorities (see guides 1-3 at commissioners are in a good position to design the services they need. They know what outcomes are required, but they also need to involve providers and service users in the design process.

Providers know about the practicalities of delivery, and service users know what the service feels like from the inside. In addition, clinicians from across the pathway will need to discuss and agree appropriate clinical standards – irrespective of where the service will be delivered.

Process-mapping will help all parties understand how the current pathway works. It may be that improvements can be identified to develop a service model that meets the commissioners' requirements. Alternatively, an entirely new model may be considered, based on understanding what would meet patient needs or best practice clinical guidelines.

The ideas for the new model may come from examples that have worked elsewhere or from guidelines from national professional bodies. It is essential to learn from others to understand what is required to establish a service and how to create a realistic financial model for it.

If the design involves commissioning a fundamentally different service model, a business case will need to be set out and approved by the PCT. Most PCTs will have a template and assessment criteria for this.

Background/relevant policy

There are two strands of policy that have been driving models of service redesign. First, with the introduction of a national tariff price for most hospital services, there is an incentive for commissioners to review services to make sure that all healthcare activity is delivering benefits to patients.

And the Government's 18-week referral-to-treatment target has focused the efforts of those whose services cross primary and secondary care to make them more efficient.

In addition, world-class commissioning competencies include ‘collaborating with clinicians' as competency number 4.

Pitfalls to avoid

• Don't let someone's pet interest drive which services are designed.
• Don't miss out on involving patients – their perspective is invaluable and they are not as demanding as you might think.
• Don't get stuck on who will provide the service or where it will be delivered. This is the task of procurement, which will take place after the service has been designed.


The 18-weeks team has developed generic pathways – see (select ‘commissioning pathways' from the menu)

Beverley Slater is national knowledge management lead and Michelle Webster is national commissioning lead for the Improvement Foundation, which runs advanced commissioning courses

Process-mapping will help all parties understand the correct pathway

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