Adelaide PHN Commissioning Framework - March 2025

Commissioning Framework Adelaide Primary Health Network (Adelaide PHN) December 2024

Contents Purpose

1

1.1 Purpose

2

Commissioning

3

Quintuple Aims

4

Commissioning Framework

5

01. Understand needs

6

02. Strategy, policy and planning

7

03. Co-design system and services

8

04. Procure, provide and partner

9

05. Monitor and advance performance

10

06. Review and evaluate

11

Commissioning Principles

12

Commissioning Enablers

13

Commissioning Levers

14

Commissioning Governance

15

Purpose

This Commissioning Framework is a practical guide to shaping the health system to deliver better outcomes for vulnerable people and a healthier Adelaide.

This Commissioning Framework documents the policy framework for how we undertake commissioning at Adelaide PHN. The purpose of this Commissioning Framework is to: Outline a best-practice approach to commissioning, and Communicate this approach to stakeholders.

Through this Commissioning Framework, we aim to: Build a shared understanding of our commissioning approach with our partners, including consumers, commissioned service providers, and other key stakeholders and organisations; Describe our methods for commissioning primary health care services; Outline our commitments across the commissioning cycle.

The Commissioning Framework aligns with Adelaide PHN’s Strategic Plan, which was developed based on the Quintuple Aims. This ensures that our commissioning approach directly supports our strategic goals[1].

This framework is for internal and external audiences. The application of this framework provides a common direction for us to move forward together.

[1] This framework should be read alongside our other frameworks, including the Access and Equity Framework and Cultural Capability Framework, which outline our commitment to equity, cultural safety, and inclusiveness.

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1.1 Purpose Our Commissioning Framework has three core parts: Commissioning Cycle

Commissioning Principles

The Commissioning Cycle illustrates the interconnected and ongoing nature of commissioning through six core stages, each with a distinct purpose. The cycle ensures that primary health care services are commissioned with people and the community at the centre.

Our Commissioning Principles guide our approach, shaping our actions and choices. They align with our vision, signature behaviours, key focus areas and strategies.

While the Commissioning Cycle outlines a staged approach, the process is often more complex.

Activities may run concurrently within each stage or recur as we adapt and refine our approach through continuous improvement. Our approach remains flexible, allowing us to adjust as needed.

Commissioning Enablers Our Commissioning Enablers are tools, resources, and conditions that help us to achieve our goals by supporting commissioning excellence. They ensure the necessary conditions and resources for success support our approach.

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Commissioning

Adelaide PHN is one of 31 Primary Health Networks (PHNs) across Australia and one of two in South Australia. PHNs are independent, not-for-profit organisations funded by the Australian Government.

PHNs deliver three core functions [2]: Coordinate and integrate local health care services in collaboration with Local Health Networks to improve the quality of care, people's experience, and efficient use of resources.

Commission primary care and mental health services to address population health needs and gaps in service delivery and to improve access and equity.

Capacity-building and providing practice support to primary care and mental health providers to support quality care delivery.

PHNs’ primary objectives are to keep people well, particularly people with chronic health conditions and mental health conditions and reduce avoidable hospital presentations in their regions. To accomplish this, PHNs deliver national programs using a 'place-based' approach – tailoring initiatives to meet their local population's health needs.

Commissioning involves assessing, planning, designing, selecting, monitoring, and evaluating services tailored to local health and service needs. The commissioning cycle outlines the structured stages that guide commissioners through activities to continuously align the primary health care system with local health needs.

Commissioning also involves a relational approach focused on partnering and co-creating with communities, service users, providers, and system leaders. This mindset encourages commissioners to coordinate and integrate primary care with other parts of the health system, build capacity, and provide support for quality care delivery.

As a commissioner, Adelaide PHN balances the structured methodology with a relational approach to ensure primary health care services are tailored to local health needs (Figure 1).

[2] Department of Health and Aged Care. Primary Health Networks (PHN) Strategy 2023-24. Australian Government, April 2024.

Available at: https://www.health.gov.au/sites/default/files/2024-04/primary-health-networks-phn-strategy-2023-24_0.pdf

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Quintuple Aims

Commissioning is critical in steering the primary health care system towards achieving the Quintuple Aims (Figure 2).

01. Improve people's experience of care.

Commissioning helps to address the fragmentation in our health system. By building a more connected and seamless network of health care services that span the primary, secondary, and tertiary care continuum, we can improve people’s care experience.

02. Improve the health of populations.

Commissioning enables a place-based approach. By thoroughly understanding our community, we can tailor services to better align with their needs, making primary health care more relevant and ultimately improving health outcomes.

03. Improve the cost efficiency of the health system.

Commissioning helps us maximise our limited resources. By ensuring that every health dollar delivers value against the quintuple aims, we can ensure primary health care services deliver measurable impact.

04. Improve the work life of health care providers.

Commissioning enables continuous improvement in care. Using data, insights, tools, and capacity building, we support commissioned service providers to deliver high-quality, evidence-based care that enables primary health care providers to operate at the top of their scope.

01

Patient Experience

Population Health

02

05

Health Equity

Reducing Costs

04

03

Care Team Well-being

05. Improve equity of access and outcomes.

Commissioning plays a vital role in ensuring equitable access to primary health care for Aboriginal and Torres Strait Islander communities and other priority groups. Commissioning directs resources to where they are most needed to improve health equity with a focus on culturally safe services.

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Commissioning Framework

Adelaide PHN’s Commissioning Framework aligns with the overarching PHN commissioning framework (Figure 3).

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01. Understand needs Purpose Understanding local health needs is the starting point of our commissioning approach.

As commissioners, we identify needs to make informed decisions on where resources are best allocated to drive outcomes and equity.

To do this, we develop a clear picture of local health needs (demand) based on our priorities, with a particular focus on equity, and assess how well these needs are met through local health service mapping and analysis (supply).

By triangulating our understanding of local health needs and service gaps, we can identify opportunities for improved health outcomes and prioritise resources to where they are most needed.

Our annual Health Needs Assessment presents our evidence base regarding health needs and identified regional and local priorities unique to Adelaide PHN.

Activities In this step, we: Build an understanding of health needs by establishing insights through detailed and systematic reviews of available data sources (qualitative and quantitative data).

Engage with communities, people with lived experience and stakeholders to gain a deeper understanding of the issues, opportunities, and priorities.

Assess the market’s ability to supply services to meet local health needs.

Use triangulation to generate rationale or decision making in prioritising resources and funding to where they are most needed.

Share a summary of our priorities through the annual Health Needs Assessment.

Commitments Use our Kitchen Table methodology to capture community views on their experiences with and expectations of the primary health care system.

Capture Aboriginal and Torres Strait Islander communities and other priority groups’ views, including people with a lived experience, on their experiences with and expectations of the primary health care system.

Use a range of data and information sources, including quantitative and qualitative data, to build and enhance our understanding of health and service needs. This may include existing reports or evidence, or the creation of new insights.

Address population and communityspecific challenges and priorities by applying a place-based approach to identify needs and equity gaps.

Set priorities in partnership with our combined Advisory Councils, PHN Board, PHN staff, and other subject matter experts to direct resources and funding to where they are needed most.

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02. Strategy, policy and planning Purpose Strategic planning creates the blueprint for the future of primary health care services.

To achieve this, we develop a vision and strategy that enables us to align our planning and stakeholders around a common purpose.

As commissioners, we lead strategic planning to ensure the primary health care system operates in an integrated way.

Our Strategic Plan outlines our blueprint for the future, and we express our commissioning intentions through our Activity Work Plans.

Our planning focuses on designing services based on health needs, allocating resources effectively, and addressing current and future health challenges.

Activities In this step, we: Develop our Strategic Plan through engagement with our stakeholders and partners.

Plan to align our commissioning intentions, activities and resources with the future direction set in our Strategic Plan.

Lead and participate in forums with system leaders to integrate health services across the region.

Partner with other funders to jointly commission services where it will improve outcomes and health equity.

Document our vision, plans and intentions in our Activity Work Plans to ensure transparency and engagement with our stakeholders.

Commitments Engage with our communities to ensure their views shape our Strategic Plan and focus areas.

Mobilise our stakeholders to build a shared understanding around our vision for system change.

Provide system leadership to align and partner with communities, commissioned service providers, health organisations, and other key stakeholders.

Partner to improve health equity and access by planning, designing, and delivering inclusive, culturally safe, and appropriate services across the primary health care system.

Partner with health providers, non-forprofit organisations, Aboriginal Community Controlled Health Organisations (ACCHOs), Aboriginal Community Controlled Organisations (ACCOs) and other stakeholders to pool resources, connections, and expertise to achieve mutual goals.

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03. Co-design system and services Purpose Co-design is a collaborative process to design services that achieve health equity and improve outcomes.

To achieve this, we engage people authentically, meaningfully, and early in the commissioning process.

As commissioners, we draw on the expertise, experience, capabilities, and knowledge of community members, including people with lived experience, and other key stakeholders to develop solutions that meet identified needs.

While design aligned with our Partnering Framework can occur at any step of the cycle, it is expected during this stage.

By leveraging local insights, we design services that deliver the best experiences and outcomes for the people we serve.

Activities In this step, we: Co-design services with communities, including people with lived experience so their perspectives shape the service.

Co-design evidence-based services with providers and subject matter experts.

Focus on outcomes-oriented design to ensure each activity delivers measurable improvements in health equity and outcomes.

Build co-design capability within our team and foster partnering.

Engage and communicate transparently throughout the co-design process to ensure alignment across all stakeholders.

Commitments Grow networks of people with lived experience and involve them throughout the commissioning cycle, including in advisory and decision-making forums.

Design place-based solutions tailored to the needs of communities where services will be accessed.

Provide resources to strengthen organisational and sector capability for effective co-design.

Co-design logic models with stakeholders to ensure activities align with the desired outcomes.

Share the results of co-design exercises with stakeholders to 'close the loop'.

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04. Procure, provide and partner Purpose Selecting the best service delivery method helps optimise outcomes from our investments.

This process leads to contracts that are focused on outcomes with agreed mechanisms to achieve results and measure success.

As commissioners, we typically commission non-government and private service providers to deliver primary health care services.

We advertise tenders, grants, and other opportunities on the Tenderlink portal, and announce the results through our communication channels.

We commission services through tenders, grants, and other opportunities. To do this, we develop plans, undertake approaches to market and run effective evaluations to secure the right services and providers for each context.

Activities In this step, we: Develop plans to understand the market and determine the most appropriate approaches to market to secure the right services and providers for each context.

Build market capacity by helping providers understand the expectations and requirements to apply for tenders, grants, and other opportunities.

Run a transparent process to select services and providers that meet the requirements.

Agree contract and payment terms, with accountability mechanisms based on the size, complexity and risk involved.

Engage with providers throughout the tender journey, offering support, guidance and transparency while maintaining probity.

Commitments Use proportional approaches to tenders, grants and opportunities that balance collaborative and competitive approaches.

Actively shape the market by encouraging new entrants, particularly smaller providers, ACCHOs and ACCOs, and by reshaping the existing market through transparent approaches to procurement.

Build capacity and address barriers to participation, especially for smaller providers, ACCHOs and ACCOs. Apply best practices, including interviews and alternative methods for ACCHOs, ACCOs and smaller providers, to encourage participation.

Ensure transparency and provide advance notice of opportunities to support quality responses.

Work with preferred commissioned service providers to develop contracts including agreements on governance, performance indicators and reporting requirements.

Provide feedback to all participants to encourage future participation.

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05. Monitor and advance performance Purpose Monitoring performance ensures our services are effective, providers are accountable, and both are continuously improving.

As commissioners, we measure, monitor, and drive continuous improvement to advance performance to deliver outcomes.

We use a range of levers to drive performance improvement and engage providers in this process (see Commissioning Levers).

Our view of health system performance is shared through our Annual Reports.

We work to create an environment where providers can thrive and are supported to achieve health equity and outcomes.

To do this, we work with commissioned service providers on the implementation, management, and ongoing monitoring of services.

Activities In this step, we: Measure and monitor performance to uphold high standards and ensure accountability for health equity and outcomes.

Engage and support providers in continuous improvement by sharing performance data and insights.

Measure, monitor and drive performance by tracking key metrics including the quintuple aim, discussing performance, and supporting providers to improve.

Use a range of levers to drive systemwide improvements.

Set and communicate clear performance expectations and drive performance through monitoring and accountability.

Commitments Partner with commissioned service providers on implementing, managing, and monitoring services.

Use a range of commissioning levers to drive performance and accountability for health equity and outcomes.

Use a balanced set of indicators to measure and monitor performance.

Share data, analysis, and insights with providers to help them identify areas for improvement.

Foster a culture of collective learning within and across organisations to advance performance by sharing best practices.

Maintain clear performance expectations and communicate them clearly.

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06. Review and evaluate Purpose Reviews and evaluations are planned, systematic collections and analyses of information and data related to PHN activities that assess the effectiveness, efficiency, and appropriateness of our services and drive continuous improvement.

As commissioners, we conduct evaluations to inform decision-making, re-design, and shape future planning.

To achieve this, we create high-quality logic models and develop evaluation plans early.

Our contracts provide agreement on which services are delivered and the approach through which they are evaluated.

To do this, we work with commissioned service providers on the implementation, management, and ongoing monitoring of services.

We use reviews and evaluations to grow the evidence base on what works, identify improvement opportunities, and ensure valuedriven decision making.

Where appropriate, we share review and evaluation findings to inspire continuous improvement.

Activities In this step, we: Plan fit-for-purpose evaluations that are supported by strong logic models.

Select evaluation methods aligned with our intended outcomes.

Establish data needs and resolve gaps as part of our early evaluation planning.

Partner with research organisations to build the evidence base.

Use evidence to drive decision-making and implementation according to findings.

Apply best practices and scale innovation across the region based on evaluation findings and recommendations.

Share insights from reviews and evaluations to inform best practice and continuous improvement.

Commitments Plan with the end in mind by co-designing robust logic models for evaluations.

Use contract reporting requirements to gather data for reviewing and evaluating services.

Match evaluation efforts to funding level, risk, innovation, or strategic importance.

Draw on providers’ expertise to inform evaluation findings.

Share findings to spread knowledge, encourage best practice, and promote continuous improvement.

Expand the evidence base of pilots and prototypes, ready to localise and scale if they prove effective and value driven.

Recommission services in a planned, safe way when necessary.

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Commissioning Principles

The following principles underpin our commissioning approach (Figure 4).

We are focused on outcomes

Use insights and evidence to inform decision-making.

Apply logic to clarify our pathways to impact.

We are committed to equity

Adopt a person-centred approach by partenering with communities and people with lived experience to ensure services meet health needs.

Prioritise cultural safety to meet the unique needs of Aboriginal and Torres Strait Islanders and other priority groups.

We are dedicated to local solutions

Commission place-based services to deliver localised care.

Co-design solutions that build on local strengths.

We are collaborative in our approach

Build strong partnerships to achieve mutual goals.

Create a connected system to integrate health care and other sectors.

Figure 4. Commissioning Principles

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Commissioning Enablers

The following enablers support our commissioning approach (Figure 5).

Our leadership creates opportunity

We lead and influence the health system to drive meaningful change. Our internal leadership strengthens our PHN, while our external leadership harnesses collective skills and resources for broader impact.

Our culture drives success together

We build a safe and inclusive primary health care system by living our signature behaviours. These behaviours support us to address challenges together with our communities, people with lived experience, commissioned service providers and partners.

Our tools support us to succeed

We equip our team and providers with the structures, systems, processes, and tools needed to improve health equity. These resources support operations, team-based care, and integrated care.

Our people drive commissioning excellence

We foster professional and personal growth opportunities, including diversity and cultural capability, for our team and providers. By cultivating an inclusive environment where they can thrive, we focus on what truly matters for communities and providers.

Figure 5. Commissioning Enablers

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Commissioning Levers

We can improve health equity and drive better health outcomes by leveraging multiple commissioning levers.

System Leadership We take a whole-system approach, working with our partners and other funders to make strategic decisions that optimise our collective resources and investments.

Clinical Engagement We engage health professionals as experts in clinical care to develop new service pathways and enhance existing ones, ensuring the consistent application of high-quality, evidence-based practices.

Community Engagement We actively engage our communities to amplify their voices and understand their perspectives, ensuring the services we commission reflect their needs and priorities.

Performance Improvement We focus on continuous quality improvement by continually enhancing health services to uphold high standards of quality and effectiveness.

Optimise Care Settings We partner with services to create integrated, seamless pathways across the care continuum, ensuring care is delivered in the most appropriate settings within the community and close to home.

Market Shaping We shape and diversify the market by signalling our commissioning intentions, encouraging providers to address service gaps through collaborative approaches or, where suitable, competitive approaches to drive innovation.

Provider Partnering We promote partnering and dialogue among commissioned service providers, focusing on sharing what works and what is best practice to achieve population health outcomes.

Investment & Funding We can drive change through financial levers that signal our expectations and encourage the desired market behaviours. This encourages providers to mobilise and adapt services accordingly.

Logic Models We use logic models to design purposeful primary health care services. We ensure our commissioning effectively meets community needs by aligning activities with expected outcomes. This structured approach provides a clear framework for driving change.

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Commissioning Governance

Our Commissioning Oversight Committee and Commissioning Life Cycle Internal Steering Group provide oversight and governance support to effective commissioning.

Our Board, the Commissioning Oversight Committee (COC), the CEO with the Executive Team, and the Commissioning Life Cycle Internal Steering Group (CLC ISG) work together to provide governance, oversight, management, and guidance on commissioning activities (Figure 6).

As our commissioning experience grows and our approach evolves, this framework will be refined and updated. The CLC ISG will review the Commissioning Framework every three years, with the chair of the CLC ISG serving as its owner. The framework and any updates will be endorsed by the COC and approved by the Board.

Adelaide PHN Board

To uphold high standards in commissioning, we continuously monitor and assess our performance.

This ensures that: Our Commissioning Framework aligns with our strategic priorities and objectives; Our commissioning practice and supporting documents reflect best practices and adapt as needed; and, We are improving health equity and outcomes.

We also submit annual reports to the Commonwealth Department of Health and Aged Care, fulfilling our funding obligations.

Commissioning Oversight Committee (COC)*

CEO *The COC is a sub-committee of the Adelaide PHN Board Executive Team

Commissioning Life Cycle Internal Steering Group Figure 6. Commissioning Governance Schematic

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