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A systematic review of the factors - barriers and enablers - affecting the implementation of clinical commissioning policy to reduce health inequalities in the National Health Service (NHS), UK

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Abstract

Objective: The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK. Methods: A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data. Results: We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level. Conclusion: This study provides useful factors e barriers and enablers e to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.

Publication Information

Output type

Research Output:
Contribution to journal
Article
 Peer-review

Original language

English

Pages from-to (Number of pages)

Pages 271-282

Journal (Volume, Issue Number)

Public Health (Volume 186)

Publication milestones

  • Accepted/In press - 19/07/2020
  • Published - 29/08/2020

Publication status

Published - 29/08/2020

ISSN

0033-3506

Publication IDs

  • handle.net: 10547/624466
  • Scopus: 85089911347

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