In the one of the first and largest studies, the Centre for Academic Primary Care (Bristol) and the University of Southampton investigated £30 million worth of contracts between healthcare commissioners and commercial and not-for-profit management consultants. From 2011 to 2014, we observed 25 meetings and training events, interviewed 92 consultants and their clients and collected hundreds of documents (e.g. meeting minutes, reports, marketing flyers).

We found: 

• Of the four contracts studied, two were only partly successful, one had short-term and another had longer-term benefits. This was largely because transferring knowledge and skills either wasn’t part of the contract or wasn’t done particularly well.
• The most valuable contracts were when commissioners actively learnt, embedded and applied new skills, rather than just outsourced work wholesale. To capitalise on the use of consultants, wherever possible, contracts should include explicit skills and knowledge transfer.
• For clients to use the information supplied, it’s not enough to deploy a software tool and provide training. Consultancies need to provide ‘translators’ who can apply outputs to local strategies, problems and issues, in discussion with local commissioners and clinicians.
• Commissioners preferred getting information through conversations and stories and regularly accessed information through five conduits:
  - Interpersonal relationships with trusted colleagues and experts
  - People placement (e.g. embedded staff)
  - Governance (e.g. Department of Health directives)
  - Copy, adapt and paste (e.g. best practice elsewhere)
  - Product deployment (e.g. software tools)
• Local information, such as service evaluations, often trumped national or research-based information in influencing commissioning decisions.
• Researchers and others who want to influence commissioners should a) access these different conduits to transfer information, b) use conversations and stories rather than written materials and c) help conduct local evaluations. This will help build relationships.

Please follow the links for a summary of our main findings or our publications, including our paper which has been published in the BMJ Open.

For more information, please contact

Dr Lesley Wye
Research Fellow
Centre for Academic Primary Care
lesley.wye@bristol.ac.uk