In 2013, the NHS underwent a significant reform, which led to general practitioner-led clinical commissioning groups (CCGs) being given responsibility for more than two thirds of the NHS commissioning budget.

The King’s Fund and the Nuffield Trust have been monitoring the progression of CCGs, and this is their second report, which has been informed by evidence-base, government policy, and responses and observations from six case studies representing CCGs across England.

Doing more with less

This year, while management budgets are being cut, CCGs are being given “optional additional joint or delegated co-commissioning responsibilities”, and this is one of the problems that this report is warning about, because there is a concern that CCGs will struggle with capacity and spread themselves too widely if they take on any more. The additional joint or delegated co-commissioning responsibilities are:

• Reviewing or renewing existing GP contracts
• Awarding new contracts
• Managing the performance of GP contracts
• Managing GP budgets
• Managing complaints
• Design and implement new local incentive schemes (LES)
• Discretionary payment decision-making.

GP leaders

Another challenge CCGs are facing with these new arrangements is the recruitment and retention of GP leaders, and maintaining their enthusiasm, which is falling for various reasons, including the increasing GP workload. The survey data included in this report clearly demonstrates that some GPs feel more engaged than others. It is essential that GPs are engaged, and their opinions heard and integrated as part of the commissioning decision-making process, and NHS England must make sure CCGs have the necessary resources to make sure this happens.

Avoiding pitfalls

This report describes five areas that CCGs and NHS England need to focus on to ensure that then new co-commissioning arrangements avoid the pitfalls and achieve their potential:

1. Support clinical leaders by investing in a strong primary care leadership strategy
2. Ensure that GPs have a voice by demonstrating clearly their involvement in commissioning decisions
3. Demonstrate transparent governance processes so that conflicts of interest can be avoided
4. Define the roles of NHS England and CCGs, so that there is no misunderstanding
5. The new responsibilities come with reduced management budgets, and this may hinder the success of the new arrangements.

The report breaks down the challenges and provides examples of different ways of working. Figure 3.7: Example of partnership working arrangements is particularly useful as it shows how different CCGs function with their partners and comments on the differences faced when working with non-NHS organisations.

Commentary

This is a really useful report for people who are new to commissioning and for those who have been involved from the start. It clearly defines commissioning and the latest changes, explaining the original responsibilities of Clinical Commissioning Groups (CCGs) and the optional additional co-commissioning responsibilities with general practitioners.

The survey data is useful, because they prompt you to think about the communication channels between your partners, so that you can decide if they are effective or not.

Take a look at your networks – are there any others that might make it easier to engage GP leaders?

As you are thinking about how you will implement these new responsibilities, think about your current partnership working arrangements, comparing them with other CCGs, and see if there is room for improvement, so that you can adjust to these arrangements without putting too much strain on human and financial resources.

Link

Holder H, Robertson R, Ross S, Bennett L, Gosling J, Curry N. (2015) Risk or reward? The changing role of CCGs in general practice, The King’s Fund, Nuffield Trust

Related links

Naylor C, Curry N, Holder H, Ross S, Marshalll L, Tait. (2013) Clinical commissioning groups: supporting improvement in general practice? The King’s Fund, Nuffield Trust

Robertson R, Holder H, Bennett L, Ross S and Gosling J (2014) Clinical Commissioning Groups – One Year On: Member engagement and primary care development. Slide pack. The King’s Fund, Nuffield Trust