ABSTRACT
The relationship between the public and services can be understood as a purchaser-provider relationship; although a designated commissioning body might purchase care services on behalf of the host community. Commissioning services requires an assessment of the host population's health needs, and will include community-based views about health needs and their priorities in contrast to professionals' perspectives. Specialist healthcare services, whilst admirable, may reflect the interests of a clinical team and their success in drawing resources, but not be warranted by local healthcare need. The commissioner will appraise the information with a view to determining the options available to meet identified needs, and to specify the quality and levels of service required. Once procured, the provider delivers the care service and establishes measures that will be part of the performance monitoring in the contract. Service development decision making has therefore to accommodate its strengths and consider how to work with internal diversity, growing some aspects, reducing others and generating new services.
