Strategic Commissioning and Service Redesign in Primary Care

At THC Primary Care, we create resources for primary care leaders. In this resource, the focus will be on commissioning with the opportunity to learn from David Mphanza - Head of Primary Care for East Berkshire, within Frimley ICB.

With the NHS 10-year health plan promising major structural changes and the transition to "strategic commissioning," healthcare leaders across the country are grappling with difficult decisions about which services to maintain, transform, or discontinue.

The timing couldn't be more critical - as ICBs face potential restructuring within two years, understanding how to thoughtfully approach service decommissioning has moved from academic exercise to urgent necessity.

In this context, learning from leaders who have been successfully navigating service transformation becomes invaluable for preserving both population health outcomes and professional relationships during turbulent times.

David shares insights on:

• Managing teams through NHS uncertainty

• The difference between commissioning and "strategic commissioning"

• How neighbourhood health differs from Primary Care Networks

• Building effective relationships across the healthcare system

• Leadership lessons from his journey from Apple to NHS commissioning

Listen to the full episode: https://podcasts.apple.com/gb/podcast/the-business-of-healthcare-podcast-with-tara-humphrey/id1477218717?i=1000716421070

About David Mphanza: David serves as Head of Primary Care for East Berkshire within Frimley ICB, overseeing a diverse population of just under 500,000 across Slough, Royal Borough of Windsor and Maidenhead, and Bracknell Forest.

His patch spans from some of the most affluent areas in the country to some of the most deprived, with demographics ranging from the youngest to the eldest populations nationally.

Before joining the NHS through the Graduate Management Training Scheme, David worked at Apple, where he developed his patient-centered approach to understanding customer needs - skills he now applies to supporting general practice transformation and population health management.

What Drives Decommissioning Decisions?

David's Framework: Return on Investment for the Population

"It's around the element of where is the best return for investment - and when I say return for investment, I mean return for investment in regards to the population."

Key Factors:

• Life expectancy gaps - particularly healthy life expectancy across different communities

• Root cause analysis - addressing causes, not just symptoms

• Independence support - keeping people healthy and independent longer

• The 20% rule - remembering medical interventions only account for 20% of individual health

Real Example from the Episode: David references a tragic case where a child died from air quality issues after repeatedly visiting healthcare services for symptoms - but the root cause (environmental) was never addressed. This drives his approach: "How do we address the cause so that will alleviate the symptoms?"

The Process: It's Redesign, Not Just Removal

David's 3-Step Approach:

1. Ask the Better Way Question

• Is there a better way to deliver this?

• Is there a better process?

• Are there better providers?

  
  

2. Test Before You Change

• Use funding streams like Better Care Fund to pilot improvements

• Take the best bits of what works

• Add new elements based on evidence

• Commission something new that yields greater results

  
  

3. Quality Impact Assessment When Necessary

• What populations will be impacted?

• How do we minimise disruption?

• Robust patient engagement through multiple channels

  
  

Real Example: Dermatology Service Transformation

Instead of decommissioning, East Berkshire added dermoscopy services:

The Problem: GPs referring borderline cases, long waits, multiple appointments The Solution: Digital dermoscopy step added locally

The Result: Patients get appropriate photos taken, shared with specialists, avoiding unnecessary hospital visits

"Sometimes I see it as redesign rather than necessarily decommissioning"

The Engagement Framework

Multi-Channel Patient Voice:

1. Practice Level: Patient Participation Groups in every practice

2. Independent Voice: Healthwatch gathering feedback separately

3. Community Insight: Voluntary sector organizations hearing different perspectives

4. Quality Impact: Formal assessment of population impact

Why Multiple Channels Matter: "There are things people might not want to share directly with us, but might with a party like Healthwatch". (However, we now know this service is being decommissioned.)

Key Takeaways for Healthcare Leaders

✅ Think Redesign First

• Start with "is there a better way?" not "should we cut this?"

• Use pilot programs to test improvements before full changes

✅ Follow the Evidence

• Some services become outdated

• New technologies and procedures emerge

• Base decisions on population health outcomes

✅ Engage Early and Wide

• Multiple channels capture different voices

• Independent feedback reveals hidden concerns

• Patient participation is non-negotiable

✅ Address Root Causes

• Look beyond medical interventions (only 20% of health)

• Consider social, environmental, and community factors

• Connect with housing, transport, air quality, social services

Why This Matters Now

With major NHS restructuring ahead, David's approach offers a blueprint for thoughtful service transformation that:

• Puts population health outcomes first

• Maintains patient trust through proper engagement

• Uses evidence and pilots to reduce risk

• Focuses on root causes, not quick fixes

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About Us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.