Working With Commissioners and NHS Partners in Complex Care at Home: Building Trust, Oversight and Shared Accountability
Complex care at home does not sit neatly within one organisation. Delivery relies on coordinated working between providers, commissioners, NHS teams and families. This article sits within the Complex Care at Home knowledge hub and aligns with the Homecare Service Models and Pathways resources on designing partnership-based delivery models.
Where relationships break down, risk increases. Where oversight is shared and transparent, complex packages are more stable, safer and more defensible under scrutiny.
Why partnership working is critical in complex care
Complex packages often involve multiple decision-makers: commissioning teams, community clinicians, hospital specialists and family advocates. Providers must operate confidently within this landscape, balancing accountability with collaboration.
Establishing clear roles and boundaries
Strong providers clarify:
- who holds clinical decision authority;
- who authorises changes to the package;
- how escalation is shared across organisations;
- how disagreements are resolved safely.
Operational example 1: Joint oversight of a high-risk package
Context: An individual with complex needs experiences frequent hospital admissions. Commissioners are concerned about sustainability.
Support approach: The provider establishes a joint oversight framework with commissioners and community clinicians.
Day-to-day delivery detail: Monthly review meetings focus on outcomes, incidents, staffing stability and escalation events. The provider shares audit findings and incident learning openly. Action plans are agreed jointly, with responsibilities clearly assigned.
How effectiveness or change is evidenced: Meeting minutes, shared action plans and reduced admission rates demonstrate collaborative risk management.
Operational example 2: Managing disagreement safely
Context: Family members request changes that staff believe increase risk.
Support approach: The provider escalates concerns through agreed channels rather than informal negotiation.
Day-to-day delivery detail: The provider documents risks, proposes alternatives and requests a multidisciplinary discussion. Decisions are recorded, including rationale and risk mitigation actions.
How effectiveness or change is evidenced: Records show transparent decision-making, protecting both the individual and provider under scrutiny.
Operational example 3: Evidence-led assurance for commissioners
Context: A commissioner requests assurance following an incident.
Support approach: The provider responds with evidence rather than narrative.
Day-to-day delivery detail: The provider shares incident analysis, learning actions, updated care plans and supervision records. Follow-up dates are agreed to review impact.
How effectiveness or change is evidenced: Commissioner feedback confirms confidence in the provider’s governance and willingness to continue the package.
Commissioner expectation: transparency and accountability
Commissioner expectation: Commissioners expect providers to be open, evidence-led and proactive in managing risk. Transparent communication builds trust and reduces reactive intervention.
Regulator expectation: partnership working that protects people
Regulator / Inspector expectation (CQC): CQC expects providers to work effectively with other professionals, share information appropriately and act in the person’s best interests when systems intersect.
Embedding partnership into governance
Effective governance includes:
- clear escalation agreements;
- regular multi-agency reviews;
- shared understanding of risk appetite;
- documented decision-making.
In complex care at home, strong partnership working is not optional. It is a core safety mechanism that protects people, providers and the wider system.