The discussions, consultation events and survey findings led the reference panel to make a number of findings and recommendations:

National findings

1. The current procurement system is unwieldy and in need of reform.

2. The Department of Health's best intentions can backfire. National efforts to increase partnerships between  the NHS and other sectors through national procurements or frameworks have demonstrated many benefits but also created local resistance to partnerships.

3. Leadership at all levels is essential to make partnerships work.

4. Perceived, and often artificial, cultural differences are an obstacle to cross-sector working.

5. Unhelpful competition between different public sector organisations hinders partnership.

Local findings

6. There are not enough partnerships between the NHS and external parties.

7. The NHS and private sector rarely contract beyond transactional relationships.

8. Procuring partnerships is not recognised by boards as one of the key processes undertaken by an NHS provider.

9. The process of defining a partnership should be enshrined in the contract.

10. For commissioners specifically: low cost does not necessarily mean high value.

Promoting partnerships - A call on national leaders

1. The Secretary of State for Health should make it clear where the responsibilities for stimulating partnership lie.

2. National NHS leadership should build a strong case for improvements through partnerships.

3. The competitive environment should not preclude Small and Medium Enterprises (SMEs), charities and not-for-profits from forming partnerships.

4. AHSNs should take the lead in equipping the NHS.

5. Competitive dialogue and soft market testing should be integral to the process, particularly in areas of high complexity or in areas where such activities have not happened before.

6. Contracts should be more outcome-focused.

7. Outcomes should be transparent and open to scrutiny.

8. NHS boards should ensure that there is a culture of encouraging the use of external skills where appropriate.

9. The private sector must adapt to the NHS system.

How commissioners can support change

10. Clinical Commissioning Groups (CCGs) should stimulate partnerships with all sectors.

11. Commissioners should take the lead in ensuring appropriate contracts are put in place to stimulate partnerships.

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