An Exploration of Hospital-based Doctors' Knowledge and Engagement of NHS Commissioning and Contracting
: A Sequential Mixed Methods Study

  • Rachel Mary Dominey

Student thesis: Doctoral Thesis


The rationale for the Study:
This research examines hospital-based doctors' knowledge of National Health Service (NHS) Contracting and linkages with the level of engagement in local healthcare commissioning, in particular contracting of clinical services. Despite widespread reform to the NHS in recent years, the quasi-market (with a commissioner/provider divide) remains, and the contract between stakeholders is a vital component of healthcare delivery.
Aim of the study:
This research aims to identify the level of knowledge and engagement hospital-based doctors have with health service commissioning, in particular the contracting of healthcare services, and to explore the enablers and barriers to engaging with commissioning.
This research has been divided and concisely represented by the following principal objectives:
● Exploring the extent of knowledge and understanding of the process, relevance, and impact of contracting within the commissioning cycle, of hospital doctors involved with service redesign initiatives
● Determining perceived enablers and barriers using a specifically designed online questionnaire
● Establishing the extent of inter-linkage between these variables
A sequential mixed methods approach was used; a questionnaire survey was completed by hospital-based doctors (n=69) and semi-structured interviews were conducted with a sample of survey respondents (n=8).
The results show there is a correlation between the level of knowledge of NHS contracts and the level of engagement in local commissioning. Key factors identified that influence engagement with contracting were the Service Improvement Leadership link to contracting (legitimacy of the contract, and accountability vs autonomy); Organisational Culture (professional vs managerial cultural barriers, and status/recognition); and the Contract Negotiation Role (business and clinical skills similarities, and transferable skills).
The study concludes that three key areas for action may improve clinical engagement in NHS contracting – Improving the Contract Relevancy (collectively agreed on standards and targets); Support for Cross-Cultural Dialogue (clarification of communication, including language used, and relationships); and Contract Negotiation Roles (developing a team focus and related competencies).
Implications for practice and research:
The findings of the study provide a greater academic and practical understanding of clinical engagement in NHS Contracting.
Date of Award26 May 2023
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorIsobel Helen Ryder (Supervisor) & Karen Elizabeth Pilkington (Supervisor)

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