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Learning disability services have been at the forefront of attempts to develop effective joint working between health and local authority agencies. There is now an emergent framework for commissioners to work together and some, albeit patchy, experience of doing so. Joint commissioning has demonstrated potential benefits for service users, though there is still considerable scope for widening the range of stakeholders and more firmly establishing it in the host organisations.

This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning.

A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five “best practice” sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups.

Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties.

Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked.

It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop.

This is one of the first large‐scale studies of joint commissioning conducted in England.

This Case Study examines how joint commissioning has been implemented in Oxfordshire in relation to learning disability services. It describes the context in which joint commissioning has developed, the Oxfordshire model for this care group, and the financial and human resources structures which support the model. The Case Study analyses some of the positive outcomes of this approach alongside areas of particular challenge.

This Case Study gives an account of the factors that led up to the joint commissioning unit (JCU) within the health and social services scene in Shropshire; analyses the concept of strategic joint commissioning; and describes the role of the JCU and how it works.

Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for Project Leaders by the Department of Health in 1995, and stemming from the roots of joint planning and joint finance way back in the mid‐1970s. Achievements have generally not been spectacular, but the issue is now squarely back on the policy stage with a rebranding: ‘integrated commissioning’. This implies a shift from ad hoc and opportunistic partnering to something more systemic and long‐term. However, the policy context is now very different, and the scale of ambition hugely heightened. This article examines whether integrated commissioning is an idea whose time has come.

This Case Study examines a practical example of joint commissioning in action, in Easington, County Durham. It explores the collaborative processes and particularly the contribution of groups operating at strategic (district) and operational (village) levels. Key individuals made important contributions to the development of a truly ‘partnership’ way of working. Impacts on services began to be made but in the period of study this was more ad hoc than systematic. In spite of some tensions between the different levels of decision making and in the face of further organisational change, the challenge for Easington is to sustain the progress made and to move forward by making further inroads into needs which span various agencies' responsibilities.

Joint commissioning is an important part of the current health and social care context and will continue to be crucial in the future. An essential component of any commissioning process is priority setting, and this paper begins to explore the idea of integrated priority setting as a key element of health and social care commissioning. After setting out the key terminology in this area and the main priority‐setting processes for health and social care, the paper describes a number of barriers that might be encountered in integrated priority setting. We argue that there are significant barriers in financing, accessibility, evidence and politics, and it is important that such barriers are acknowledged if priority setting is to become a component of joint commissioning. While these barriers are not insurmountable, the solution lies in engagement with a range of stakeholders, rather than simply a technical process.

This local case study reviews progress in joint working in adult services in a county which has been developing innovative partnership arrangements for some years. It is a follow‐up to an article in this journal in Issue 10.2 April 2002 (The road to integration in Hertfordshire) and focuses particularly on practical issues which have now arisen from the work of the county‐wide joint commissioning board. This will be of interest to other localities where complex collaborative arrangements are needed because several PCTs are working with one local authority.

In the second of two articles, the authors consider whether the evidence of joint commissioning's limited success has influenced the new partnership flexibilities. They conclude that, while they offer significant opportunity, their positive elements may be undermined by lack of recognition of the unavoidable complexity of the organisational environment in the health and social care field.