• Claire Reidy, Anne Kennedy, Catherine Pope, Claire Ballinger, Ivo Vassilev, and Anne Rogers.
• Faculty of Health Sciences, University of Southampton, NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, Hampshire, UK.
• BMJ Open. 2016 Jul 15; 6 (7): e010853.

ObjectivesTo explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need.DesignA multisite, quasi-ethnographic exploration of 9 CCGs.SettingNational Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas.Data Collection/AnalysisContent analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30 hours).ResultsObservations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services ('person-centred', whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.ConclusionsCommissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic planning of lay involvement to provide an avenue for genuine engagement, so that support can be provided for communities and individuals in a way people will engage with.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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