Clinical Commissioning Groups: one year on

By Neil Perkins

This was a well attended seminar hosted by PRUComm, The Nuffield Trust and the King’s Fund, on 1st May at The King’s Fund, London. Those attending included academics, policy makers and practitioners.

In April 2013 clinical commissioning groups (CCGs) took over responsibility for £65 billion of the NHS budget. One year on, the seminar reflected on progress made by CCGs during their first year in operation, and discussed key issues for their future development.

Three presentations were given at the seminar:

• Exploring the ‘added value’ clinicians bring to commissioning: views from the ground

This presentation was given by Dr Katherine Checkland (PRUComm). In the presentation, evidence was presented from an on-going study of CCGs as to what knowledge; skills and abilities clinicians (especially GPs), bring to CCGs. The research found that GPs believed they have a knowledge from working on the’ front-line’ and see their patients on a regular basis and thus know the problems and difficulties they encounter. They are able to feed back such experiences to managers, and the wider bodies of the CCG. Furthermore, GPs clinical knowledge is needed to inform service provision, pathway development and contextualise policy etc. It was being claimed that GPs bring a concrete knowledge of how the NHS actually performs in practice to the commissioning process, based in the real experiences of patients. Furthermore, that knowledge is fine-grained, distinguishing in detail between the experiences of different categories of patients and between services. Dr Checkland argued that although such knowledge is valuable, it may be not be used in a systematic and joined up manner and there is a danger that the focus on the value of this type of knowledge may crowd out more systematic population health knowledge and data.

CCGs: engaging members and supporting primary care development

Holly Holder (Fellow in Health Policy, Nuffield Trust) and Ruth Robertson (Fellow, Health Policy, The King’s Fund). In this presentation Holly Holder and Ruth Robertson reported on the latest findings from their study of CCGs they found that:
• One year on, CCGs have managed to broadly maintain overall levels of engagement, although fewer GPs remain highly engaged.
• CCGs were the organisation reported as having the greatest influence over GPs’ work; fewer said health and wellbeing boards were influential at this stage.
• GPs increasingly accepted that their CCG has a role in primary care development, and many saw the CCG as more effective at this than the previous PCT.
• There were signs that CCGs are influencing general practice. Some GPs reported their CCG has improved relationships between GPs, promoted multidisciplinary team working, and changed referral and prescribing behaviours. Fewer reported a positive impact on the overall quality of care they provide.

• Commissioning health care: comparing theories, policies and practice

Professor Rod Sheaff is a Professor in Health Services Research, Plymouth School of Government, Plymouth University. In this presentation Professor Sheaff presented the results of a recent NIHR-funded study which compared commissioning across three European countries. The team spent some time investigating the ‘programme theories’ underlying the English NHS reforms, and then compared these with the reality on the ground. The study report will soon be published on the NIHR website.

After the presentations a discussion followed, chaired by incoming Chief Executive of the Nuffield Trust, Nigel Edwards. The discussion questions included:
• Over the next year, what should CCGs focus on in terms of member engagement and primary care development?
• On which CCG activities should GP board members and other GPs with a formal role in their CCG focus their efforts?
• What policy changes would make CCGs role easier?

The diverse audience included CCG staff, academics, policy makers, staff from NHS England and representatives from the voluntary sector. The discussion was lively, and there was a general agreement that CCGs most of all need a period of policy stability to allow them to focus on the financial challenges facing the NHS. There was also a clear consensus that CCGs have an important role in supporting primary care development.

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