Commissioning Pathways of Care

Define the Pathways
Specify the Pathway Lead
Clinical expert access


King’s Fund. The future of leadership and management in the NHS:no more heroes 2011.

Report of the Mid Staffordshire NHS foundation Trust Public Inquiry (Francis report) 2013

A vertical pathway of care consists of the stages a patient will pass through as they are investigated and treated for their illness. It is outlined by who the patient meets and the path for each patient runs from presentation to resolution or stabilisation of the illness. Current examples nationally are stroke care and warfarin monitoring. The Pathway is the intended route for a particular clinical condition. The path is the actual route taken by a patient

Define the Pathways

When healthcare is commissioned the pathway of patient care should be defined within the contract by at least the expected starting and end points. The provider should submitt a clear outline of each clinical care pathway that has been commissioned. This should include a job description and person specification for the lead person and lead clinician overseeing the pathway. There is a “duality” of process with clinical leadership and administration expertise.

Specify the Pathway Lead

The lead person for a clinical care pathway has responsibility to oversee the pathway and act as a focal point for feedback. Their role is to ensure the patient passes through their path of care as efficiently as possible. They review and update the expected pathway, identify and resolve problems within it. The lead is usually working in some part of the pathway, has clinical knowledge of the relevant illness and is empowered to collate feedback as well as make changes in the pathway. Examples nationally are the leads for stroke care, anticoagulation monitoring, parkinsons and epilepsy care. In many cases the lead has a nursing background.

Clinical expert access

The clinical lead oversees the pathway and is available for clinical advice to those using the pathway. They will usually see the more complex patients and provide telephone advice to healthcare workers such as general practitioners and nurses. They will usually be a doctor with experience in handling all presentations of the relevant illness.

The aim is for the pathway and clinical leads to act in a professional way by reviewing the local processes on the basis of feedback and their knowledge on how patients have passed along their path of care.

“Targets and terror” 1 have produced change but have lead to perverse incentives and demotivation. A focus on leadership that is “shared distributive and adaptive” 1 across all parts of the care pathway, has a close duality between clinical leads and management leads, and has professional freedom to focus on local outcomes, is the way forward. Clinical leadership and overview of patient care is recommended by the Francis report on patient care problems in Mid Staffordshire 2


1) King’s Fund. The future of leadership and management in the NHS:no more heroes.2011.

2) Report of the Mid Staffordshire NHS foundation Trust Public Inquiry (Francis report) 2013