The working group defined the principles of good governance to include:
- Putting the service user first: The service user perspective has to drive the operating model.
- Hold providers accountable: Financial risk and delivery risk (e.g., outcomes) must be assessed, distributed and mitigated by the commissioner. Ways to enforce should include financial penalties/incentives and exit clauses in contracts based on outcomes (balanced by increase in length of contract terms to give stability for providers).
- Involve primary care and the third sector: GPs must be incorporated into the provider vehicles to ensure the appropriate referrals are made through the system.
- Work towards a shared set of outcomes: As much as possible, all commissioners should work towards a shared single set of service user outcomes which includes and surpasses meeting the statutory requirements of each commissioner.
Having set up the initial workings of pooled commissioning, shared decision-making bodies should be formed which enable effective and decisive joint commissioning on an ongoing basis. This requires both the tactical capabilities for commissioning and performance management of joint provider networks, as well as the more strategic capabilities to make sure the statutory obligations of both social- and healthcare commissioning groups are met.
Within joint commissioning frameworks which are more deeply integrated, the tactical aspects of joint commissioning can be delegated more easily to share staff with a good understanding of the statutory obligations. In both cases of a care trust and a commissioner with delegated management responsibility, a single commissioning function will be able to manage providers of integrated care to ensure both social- and health-care outcomes meet statutory obligations. In these cases, a shared board, with key representatives from all commissioners as well as lay partners should meet (initially on a frequent basis) to review progress, ensure statutory requirements are being met, and set high-level direction for the shared organisation to follow.
Within joint commissioning frameworks which are less integrated, like a partnership agreement or a delegation of funds/functions, more high-level attention must be paid, at least initially, to the pooled activities. Without shared teams of commissioners working together, a joint board should meet as often as needed to make decisions on tactical pooled commissioning decisions.