MURRUMBIDGEE
PRIMARY HEALTH NETWORK
Commissioning Framework
v2.0 September 2025
Purpose
This Commissioning Framework sets out Murrumbidgee Primary Health Network’s (MPHN) approach to commissioning. It serves as a practical guide for commissioning a primary healthcare system in the Murrumbidgee region. It sets out the framework that guides how we commission services.
The purpose of this framework is to:
• Outline a best-practice approach to commissioning; and,
• Communicate this approach to our stakeholders.
Through this framework, we aim to:
• Build a shared understanding of our commissioning approach;
• Describe our commissioning methods for primary healthcare services; and,
• Outline our commitments at each stage the commissioning cycle.
At MPHN, commissioning is everyone’s responsibility. We take a whole-of-organisation approach, recognising that every role contributes to shaping the primary healthcare system. This framework supports collaboration across teams, harnessing our collective expertise to improve health outcomes.
The Commissioning Framework aligns with MPHN’s Strategic Plan, which was developed based on the principles of the Quintuple Aim of healthcare (Quintuple Aim). and with other key strategic frameworks1. This ensures that our commissioning approach directly supports our strategic goals.
This framework is intended for both internal and external audiences. It provides a shared direction that enables us to move forward together, as one health system.
1 This framework should be read alongside MPHN’s other strategic plans, frameworks and policies. See Appendix A: Related Documents
Figure 1. Whole of organisation approach
Structure of the Framework
Our Commissioning Framework has three core components:
Commissioning Cycle
The Commissioning Cycle reflects the interconnected, continuous nature of commissioning across six core stages, each with a distinct purpose. It ensures that people and community remain at the centre of commissioned primary healthcare services.
While the cycle outlines a staged approach, commissioning is often more dynamic. Activities may run concurrently or recur as we adapt and improve. Our approach is flexible, allowing us to adjust as needed.
Commissioning Principles
Our Commissioning Principles guide our approach, shaping our actions and decisions. They align with our vision, purpose values and focus areas.
Commissioning Enablers
Our Commissioning Enablers are tools, resources, and conditions that support commissioning excellence. They help create the environment and capacity needed for successful commissioning.
Commissioning
MPHN is one of 31 Primary Health Networks (PHNs) across Australia and one of 10 in New South Wales. PHNs are independent, not-for-profit organisations funded by the Australian Government to coordinate primary healthcare in their regions2
PHNs deliver three core functions3:
• Coordinate and integrate local healthcare services in collaboration with Local Hospital Networks to improve the quality of care, people’s experience, and efficient use of resources.
• Commission primary care and mental health services to address local 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 illness, 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 healthcare system with local health needs.
Commissioning also involves a relational approach focused on partnering and co-designing with communities, service users, providers, and system leaders. This mindset encourages commissioners to coordinate and integrate local health with other parts of the health system, build capacity, and provide support for quality care delivery.
As a commissioner, MPHN balances a structured methodology with a relational approach to ensure primary healthcare services are tailored to local health needs (Figure 2).
2 What Primary Health Networks are | Australian Government Department of Health, Disability and Ageing
3 Department of Health, Disability and Ageing. Primary Health Networks (PHN) Strategy 2023-24. Australian Government, April 2024.
Detect when we need to drive change in our system.
Make tactical and evidence-based decisions about how to drive change.
Organise change successfully using the right levers.
Sustain change with lasting benefits aligned to the Quintuple Aim.
Figure 2. Framework for driving commissioning change
Quintuple Aim of healthcare
Commissioning plays a critical role in steering the primary healthcare system towards achieving the Quintuple Aim4 (Figure 3). We consider the Quintuple Aim at every stage of the commissioning cycle; using its pillars to guide decisions and prioritise actions that deliver the greatest impact for the health system.
Improving consumer experience
Commissioning strengthens the integration of primary, secondary, and tertiary care to create a more connected, coordinated, and person-centred health system. By reducing fragmentation and improving continuity of care, commissioning enhances consumers’ experiences at every point of their healthcare journey.
Improving population health
A place-based commissioning approach ensures services are designed around the unique needs, strengths, and cultural contexts of local communities. By aligning investment with population health priorities, commissioning supports more equitable access, culturally safe care, and improved health outcomes across the region.
Reducing costs and improving value
Commissioning drives value for money by ensuring every health dollar delivers maximum impact. Through evidence-informed decision making, transparent prioritisation, and continuous improvement, commissioning ensures resources are used effectively and efficiently to strengthen the overall sustainability of the health system.
Improving provider experience
Commissioning supports a strong and sustainable local primary health workforce. By leveraging data, insights, digital tools, and capacity-building initiatives, we enable providers to deliver high-quality, evidence-based care and to work confidently at the top of their scope within a supportive system.
Health equity
Achieving health equity is both a goal and a guiding principle of commissioning. We are committed to removing barriers to care for Aboriginal and Torres Strait Islander communities and other vulnerable populations by ensure our resources are directed where they are needed most to reduce disparities and improve health outcomes for all.
Figure 3. Quintuple Aim of healthcare
Commissioning Framework
MPHN’s Commissioning Framework aligns with the overarching PHN Commissioning Framework (Figure 4).
Figure 4. Commissioning Framework
1. Identify Needs
Purpose
Understanding local health needs is the foundation of our commissioning approach.
We seek to understand the health status of communities, service gaps, emerging trends, community aspirations, and the systemic factors driving inequity. This understanding enables us to shape services and system that are responses to local needs.
We build a comprehensive picture of local health needs by analysing both demand (population health analysis) and supply (mapping existing services). By triangulating demand and supply with other data, including lived experience and qualitative insights, we identify gaps, inequities, and opportunities to target resources where they will have the greatest impact.
Our Health Needs Assessments form the evidence base for commissioning, identifying local and regional priorities that guide investment and decision-making.
A needs assessment is a cyclical, iterative process. Through data analysis, community engagement, and service feedback we continuously update our understanding of local health needs to ensure commissioning remains relevant, responsive, and equitable.
Activities
→ Engage communities, stakeholders, and people with lived experience to gather qualitative data to understand local issues, opportunities, priorities, and strengths.
→ Analyse quantitative data to generate insights into population health status by applying population segmentation, risk stratification and scenario modelling to better identify the specific needs of subgroups.
→ Assess market capacity, including infrastructure, workforce, and digital maturity, to meet identified health needs.
→ Triangulate qualitative, quantitative, and market insights to prioritise unmet needs and service gaps for commissioning.
→ Communicate findings through our Health Needs Assessments, ensuring transparency and alignment with community expectations and strategic goals.
Approach
→ Apply strengths-focused approaches that recognise cultural resilience, protective factors, and community assets to understand and respond to local health needs across the Murrumbidgee region.
→ Capture community perspectives through Conversations on the Couch, Yarns on the Couch, and other structured community feedback mechanisms with ACCHOs, LHDs, GPs, councils, advisory committees, and providers as sources of real-time intelligence.
→ Apply a place-based lens to identify population and location-specific challenges using Local Government Area and First Nation profiles
→ Integrate national, state, and local data through our Population Health Tool to create a comprehensive view of demand, supply, and system performance.
→ Set clear commissioning priorities in partnership with Clinical Councils, the Community Advisory Committee, alliances and consortiums including the Murrumbidgee Aboriginal Health Consortium, the MPHN Board, staff, and sector experts to ensure investments achieve maximum impact.
2. Strategy & Planning
Purpose
Strategic planning sets the blueprint for a high performing, equitable primary healthcare system.
At MPHN, we lead strategic planning to ensure our commissioning is aligned with identified needs, guides investment priorities, and fosters collective impact through collaboration with stakeholders. We do this by developing a shared vision and aligning stakeholders around common strategic objectives.
Our planning approach ensures a coordinated effort to meet current and emerging health needs, integrate services across the system, and align operational plans with strategic goals. We also partner with other funders and stakeholders to co-commission services and maximise collective impact across the broader health system.
Our Strategic Plan sets the long-term vision for a healthier, more equitable region, while our Activity Work Plans translate that vision into action.
Activities
→ Develop our Strategic Plan in partnership with our stakeholders to reflect regional priorities, system challenges and emerging trends.
→ Align commissioning intentions, activities and resources with our Strategic Plan to ensure a coordinated approach to improving health outcomes and achieving equity.
→ Lead and participate in regional and state planning forums to strengthen alignment, integration, and shared accountability.
→ Partner with other funders to pursue co-commissioning opportunities that deliver greater value, impact, and health equity.
→ Document and communicate our commissioning intentions and goals through Activity Work Plans ensuring transparency and engagement with stakeholders.
Approach
→ Engage with our communities, Community Advisory Committee and Clinical Councils to ensure local perspectives, lived experience, and health expertise shape our Strategic Plan and commissioning priorities.
→ Promote a ‘one system’ mindset through collaborative system leadership and shared planning efforts across sectors:
• Working with the Murrumbidgee Local Health District through the Murrumbidgee Health Collaborative.
• Regional planning with other health sector partners (including the Murrumbidgee Local Health District) through the Murrumbidgee Health and Knowledge Precinct.
→ Support and participate in service alliances, such as the Murrumbidgee Mental Health, Drug and Alcohol Alliance, to develop regional solutions and implement joint workplans that reflect community needs.
→ Collaborate nationally through the PHN Cooperative to deliver initiatives that extend beyond MPHN.
3. Co-design Services
Purpose
Co-design is a collaborative process to design services that improve health outcomes and achieve health equity.
Co-design is a strengths-based process grounded in mutual respect, cultural safety, and shared decision-making. It enables communities and service users to play an active role in shaping the health system.
Through co-design we commission services that are person-centred, culturally safe, and locally responsive. By working in partnership with communities, people with lived experience, providers, and system leaders, the services we commission reflect real needs, preferences, and strengths.
While collaboration can occur throughout all stages of the commissioning cycle, it is especially critical during this stage for both new and existing services and is essential to our commitment to improving health equity.
Co-design builds trust, fosters innovation, and supports the development of integrated models of care that work for diverse populations across the Murrumbidgee region.
Activities
→ Co-design services with communities and people with lived experience to ensure services are shaped by those who use them.
→ Co-design with providers and subject matter experts to ensure services are evidence-informed and reflect best practice.
→ Focus on outcomes-driven co-design to ensure services are designed to deliver measurable improvements in health outcomes and the achievement of health equity.
→ Build co-design capability and confidence in co-design practices, through training, tools, and ongoing support for staff and stakeholders.
→ Engage continuously throughout the co-design process to build shared ownership and communicate transparently and ‘close the loop’ by communicating how input has influenced service design.
Approach
→ Champion our four core co-design principles: Equity, Diversity, Accessibility and Reciprocity
→ Involve our community advisory groups to ensure community voice are central, including Community Advisory Committee and Local Health Advisory Committees.
→ Engage with our local subject matter experts including Clinical Councils, alliances and consortiums to ensure service design is clinically informed, locally relevant, and aligned with identified community needs and system priorities.
→ Enable Aboriginal-led co-design through the Murrumbidgee Aboriginal Health Consortium to uphold cultural authority and self-determination.
→ Ensure co-design methods are culturally safe and trauma-informed when working with Aboriginal and Torres Strait Islander communities and other priority groups.
→ Promote inclusive engagement through open opportunities and targeted approaches for priority populations and underrepresented voices, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse communities, people with disability, older people, and LGBTQIA+ individuals
→ Reflect on co-design processes and document learning to embed continuous learning and ensure future co-design activities are meaningful and outcome focussed.
4. Procure & Contract
Purpose
Selecting the best service delivery method is critical to achieving improved health outcomes and health equity.
Procurement is the process of identifying and contracting providers best suited to meet local health needs. As commissioners, we typically commission non-government and private providers to deliver primary healthcare services that align with regional priorities and Activity Work Plans.
We use a range of procurement methods including tenders, grants, and other market approaches to source services tailored to each context.
Procurement plans guide our approach to the market and ensure robust, transparent evaluations that identify the best-fit providers. This process results in outcome-focused contracts with clear expectations for delivery, accountability, and performance monitoring.
Procurement opportunities are typically advertised on MPHN’s website and Tenderlink, with outcomes communicated through our public channels.
Activities
→ Assess the market to determine the most appropriate procurement strategy based on risk, complexity, and context.
→ Build market capacity, including support for local, rural and smaller providers, to reduce barriers to participation and strengthen commissioning readiness.
→ Develop procurement documentation and tender evaluation plans aligned with the chosen procurement strategy and conduct proportionate procurement processes in line with probity principles.
→ Negotiate outcome-focused contracts with agreed payment mechanisms, governance, and performance monitoring terms relative to the size, complexity and risk involved and aligned with MPHN’s Monitoring and Evaluation Framework.
→ Maintain provider engagement throughout the procurement process while upholding fairness, transparency, and accountability.
Approach
→ Tailor our procurement to suit the service need, using methods such as open tenders and dialogue-based procurement especially where co-design is a priority.
→ Support local, rural and smaller providers to build capability and confidence to participate in procurement and broader commissioning initiatives.
→ Host collaborative forums to explore interest, explore new ideas, and identify innovative service models.
→ Apply consistent logic model frameworks to link commissioned service models to identified health needs, outcomes, and the Quintuple Aim.
→ Adhere to best practices and governance requirements guided by MPHN’s Procurement Guide and Conflict of Interest Policy, ensuring fairness, proportionality, transparency, and probity at all stages.
5. Manage & Monitor
Purpose
Monitoring performance ensures our services are effective, providers are accountable, and both are continuously improving.
As commissioners, we take a proactive and relational approach to performance monitoring. We measure results, identify areas for improvement, and use data to drive improve health outcomes and achieve health equity.
We work in partnership with commissioned providers to create an environment where they can thrive. This includes supporting implementation, management, and ongoing monitoring of services.
We use a range of levers to drive performance improvement and engage providers in this process (see Commissioning Levers).
Performance insights are regularly shared with the Executive, Board, providers, and where appropriate, our communities to support shared accountability. Our view of health system performance is shared through our Annual Reports.
Activities
→ Use commissioning levers to support both service-level and system-wide improvements.
→ Measure and monitor system performance to uphold high standards and ensure accountability for improving health outcomes and achieving health equity, including indicators linked to the Quintuple Aim.
→ Measure, monitor and drive provider performance by tracking key metrics, collaborative review, and performance discussions.
→ Engage and support providers in continuous improvement through professional networks, capability building, feedback loops, and shared problem-solving.
→ Set and communicate clear performance expectations using monitoring and accountability to drive improvement.
Approach
→ Foster trusted, collaborative relationships with providers to enable constructive performance dialogue, support continuous quality improvement, and target strategies based on benchmark and recovery expectations.
→ Embedding performance monitoring and continuous feedback within an adaptive commissioning model to ensure services remain responsive, outcomes-focused, and deliver value for money.
→ Facilitate provider network forums such as the Allied Health Forum and Murrumbidgee Aged Care Forum to share successes, strengthen collaboration, and build communities of practice.
→ Measure performance against the Quintuple Aim, including patient reported experience and outcome measures (PREMs and PROMs) to assess satisfaction and overall service impact.
→ Share system performance insights with stakeholders to demonstrate accountability, transparency, impact, and confidence in the primary healthcare system.
6. Review & Evaluate
Purpose
Reviews and evaluations are structured processes that assess the effectiveness, efficiency, and appropriateness of commissioned services.
As commissioners, we conduct evaluations to enable continuous improvement, strengthen accountability, and guide future investment decisions.
To achieve this, we create high-quality logic models and develop evaluation plans early in the commissioning cycle which are incorporated into contracts and service agreements.
Evaluations build the evidence base for what works, support service re-design, and guide re-commissioning to ensure that our investments deliver against the Quintuple Aim. This ensures that learning is embedded, practice evolves, and commissioning remains responsive, equitable, and evidence informed.
Activities
→ Plan fit-for-purpose evaluations early in the commissioning cycle, supported by robust logic models.
→ Establish data needs and resolve gaps as part of our early evaluation planning.
→ Select evaluation methods that are aligned with the changes we seek to understand.
→ Partner with research organisations where appropriate to undertake evaluations and build the evidence base.
→ 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.
→ Use evidence to drive decision-making and implementation according to findings.
Approach
→ Plan evaluations early in the commissioning cycle, using logic models to define service objectives and select methods appropriate to the complexity, risk, and learning goals.
→ Ensure evaluations meet ethical guidelines when handling sensitive personal health data and respect cultural safety and trauma-informed standards when involving First Nations communities and other priority populations.
→ Undertake evaluations internally or with external partners such as research organisations, based on the purpose, risk, complexity and required level of independence required.
→ Use evaluation findings to shape service redesign, recommissioning, strategic priorities, and future commissioning decisions on reinvestment or decommissioning.
→ Share evaluation outcomes internally, with providers, and through sector forums and conferences to promote best practice, scale innovations, and embed system-wide learning.
Commissioning Principles
The following principles underpin our commissioning approach (Figure 5).
5. Commissioning principles
Commissioning Enablers
The following enablers support our commissioning approach (Figure 6).
Figure 6. Commissioning enablers
One system
We collaborate with our partners to build a connected, seamless, and sustainable healthcare system for the Murrumbidgee region.
Outcomes-focused
We are clear about the results we seek and can demonstrate how our work is evidence-informed in line with the Quintuple Aim.
Equity
We place equity at the centre of our commissioning. We target our efforts toward priority populations, elevate community voices and lived experience, and work to remove barriers to access and care through culturally safe services.
Local solutions first
We prioritise locally driven solutions by supporting local providers, strengthening community partnerships, and addressing the unique dynamics of regional primary healthcare.
Our leaders
We lead and influence the health system to drive meaningful change by strengthening our organisation and leverage partnerships for broader impact.
Our people
We invest in the growth, diversity, and cultural capability of our team and providers, fostering an environment that supports them to work at the top of their scope.
Our partners
We build strong partnerships that enable us to work across organisational boundaries to create a connected, integrated healthcare system.
Our supports
We provide the structures, systems, processes, and tools that enable our team and providers to deliver equitable, coordinated, and team-based care.
Figure
System leadership
We use a ‘one system’ approach, collaborating with partners to make strategic decisions that optimise collective resources, investments, and outcomes across the region.
Clinical engagement
We engage health professionals to develop and enhance service pathways, ensuring the consistent delivery of high-quality, evidenceinformed, and person-centred care.
Community engagement
We actively engage our communities to amplify their voices and ensure services we commission reflect local needs, priorities, and lived experience.
Optimise care settings
We partner with providers and stakeholders to codesign seamless, integrated care pathways, ensuring care is delivered in the most appropriate settings, closer to home and within the community.
Provider partnering
We foster collaboration among service providers, promoting shared learnings, innovation, and best practice to improve health outcomes and strengthen the local health system.
Commissioning Levers
We improve health outcomes and achieve health equity in Murrumbidgee by applying multiple commissioning levers.
Performance improvement
We drive continuous quality improvement, supporting providers to enhance effectiveness, efficiency, and the delivery of safe, high-performing care.
Market shaping
We shape a diverse and responsive local provider market through collaborative and competitive procurement approaches. Where suitable, we also co-fund services to strengthen system collaboration and capacity.
Investment & funding
We use financial levers to influence market behaviour, incentivising performance and alignment with commissioning goals through value-based payments and other funding models where appropriate.
Logic models
We apply logic models to ensure services are designed and delivered in alignment with local needs, providing a structured, evidence-based framework for improving outcomes and advancing health equity.
Commissioning Oversight
Commissioning governance
Our governance structure provides oversight and support to ensure commissioning is strategic, effective, and accountable. Governance roles include:
• MPHN Board – Provides strategic oversight and approves this Commissioning Framework and significant updates.
• Clinical Governance Committee – Provides oversight of commissioning strategy, risks, and performance to ensure quality and safety in commissioned activities.
• Chief Executive Officer (CEO) – Accountable for ensuring commissioning aligns with strategic priorities and performance expectations.
• Executive Leadership Team (ELT) – Leads implementation of the Commissioning Framework and monitors commissioning practice, continuous improvement, and performance.
• MPHN Senior Leadership Team (SLT) – Provides operational oversight of end-to-end commissioning across all stages of the commissioning cycle, ensuring alignment with organisational priorities, governance requirements, and performance outcomes.
• MPHN Contract Management and Procurement Team – Provides operational oversight and consistency procurement and contracting activities across all commissioned services.
MPHN also submits annual reports to the Department of Health, Disability and Ageing meeting funding obligations and demonstrating performance.
Continuous improvement
To uphold high standards in commissioning, we continuously monitor, evaluate, and refine our performance. This ensures that:
• The Commissioning Framework remains aligned with the Strategic Plan and other strategic frameworks;
• Commissioning practice, tools, and supporting documents reflect current best practice and adapt to new evidence and policy changes; and,
• Commissioning activity delivers measurable improvements in outcomes and advances progress towards health equity.
Implementation of the Commissioning Framework
MPHN will implement this framework through a structured and collaborative approach, supported by:
• Capability building – Strengthening the knowledge, skills, and confidence of staff involved in commissioning.
• Embedding commissioning practice – Integrating this framework into organisational procedures, templates, procurement processes, and quality systems.
• Governance oversight – Ensuring appropriate oversight through the Clinical Governance Board Sub-committee and internal management structures.
• Performance monitoring and reporting – Regularly monitoring and reporting commissioning performance to the Executive Leadership Team and Board.
• Continuous improvement – Undertaking regular reviews of commissioning maturity and implementing improvement actions to drive ongoing effectiveness.
Appendix A: Related Documents
→ Operations Manual – Contract Management Guide
→ Operations Manual – Procurement Guide
→ Unsolicited Proposals Policy
→ Decommissioning Policy
→ Data Governance Framework
→ Clinical Governance Framework
→ Quality Management Framework
→ Risk Management Framework
