The Health and Social Care Act 2012 gave the power and responsibility for commissioning health services and budgets to groups of GP practices called Clinical Commissioning Groups (CCGs). CCGs will commission the great majority of NHS services for their patients but will not be directly responsible for commissioning services that GPs themselves provide. The responsibility for commissioning primary care services (medical, dental, eye health, and pharmacy) was given to a new statutory organisation called NHS England (NHSE), known as the NHS Commissioning Board in statute. This was to ensure a more standardised model and consistency in the management of the four groups.
In May 2014, following Simon Stevens appointment as the Chief Executive of NHS England, CCGs were delegated the responsibilities to commission primary care services. This was to enable better integrated care outside hospitals, ensure that primary, community and mental health are properly resourced, and CCGs having more influence over how funding is invested for local population, which would ensure sustainability of their local NHS. Co-commissioning would also enable the development of new models of care such as multispecialty community providers (MCPs) and primary and acute care systems (PACSs), as set out in the NHS Five Year Forward View.
This report presents the findings from a study following the development of Clinical Commissioning Groups (CCGs) in England. This is the third phase of the project, which aims to understand the ways in which CCGs are responding to their new primary care co-commissioning responsibilities from April 2015, providing feedback to NHSE supporting CCGs going through the approval process.
The study provides detailed evidence about the experiences of CCGs as they took on delegated responsibility for primary care commissioning. The study took place between May 2015 to June 2017. The strength of this study lies in the bringing together of evidence from senior policy makers as to the overall objectives for the policy with both telephone survey and case study evidence as to how it is playing out in practice. The specific research questions addressed in this report are:
- What is the scope of co-commissioning activity and the process of change?
- What approaches have been taken by CCGs to:
- Develop governance structure to oversee primary care co-commissioning?
- Commissioning and contracting?
- Manage and develop the relationships between CCGs and their membership and between CCGs and external stakeholders?
- Manage conflicts of interest?
- What are the impacts and outcomes CCGs would expect from taking on delegated responsibility and claims of early successes?
- What factors have affected CCGs’ progress and development?
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Since the establishment of PRUComm in 2011 our research has focused on examining how the changes to the English NHS and public health system have developed. We continue to examine the development of CCGs and the new commissioning structures. We have also been exploring the mechanisms by which commissioning is undertaken, such as contracting and the use of competition and cooperation within the new system.
While most media attention has focused on changes to the commissioning and delivery of healthcare, the shift of public health to local authorities was a major part of the reforms introduced in April 2013. We have examined the progress and developments in the public health system with a particular emphasis on how governance and organisational structures develop and whether being embedded within local councils changes the way that public health services are provided. We have also been focusing on primary and community health care with recent projects examining general practice – including methods of funding primary care; research on recruitment and retention; QOF, scaling up primary care and running and analysing two rounds of the GP WorkLife survey (eight and nine).
Our research on CCGs has most recently focused on primary care co-commissioning and new forms of contracting, such as outcomes-based and alliancing. Given the increasing policy emphasis on this area of healthcare we anticipate that we will be increasingly involved in further research on primary and community healthcare. All these topics will be explored in today’s seminar with presentations by researchers from PRUComm.
Programme and speakers biographies [pdf]>>
9.30 Registration and refreshments
10.00 – Welcome and introduction: Professor Stephen Peckham (Director PRUComm).
10.00 – 10.25 Jonathan Walden: (Commissioning Policy Lead): Policy update – Department of Health and Social Care priorities. Slides [pdf]>>
10.25– 11.00 Dr Lindsay Forbes: Incentivising GPs: Review of the Quality and Outcomes Framework in England. Slides [pdf]>>
11.00 – 11.20 Coffee
11.20 – 12.00 Dr Jon Gibson and Prof Kath Checkland: Satisfaction, sources of stress and intentions to quit amongst GPs in England: the results of the 9th GP Worklife survey
12.00 – 12.40 Dr Marie Sanderson: Examining the implementation of new models of contracting in the NHS: what are the lessons for the formation of Accountable Care Systems?
12.40 – 13.20 Lunch
13.20 – 14.00 Dr Valerie Moran: How are CCGs managing conflicts of interest when they commission primary care? Lessons for Accountable Care. Slides [pdf]>>
14.00 – 15.50 Panel Discussion – STPs, and ACS’s the re-emergence of planning?
15.50 – 16.00 Professor Stephen Peckham: Current PRUComm research programme
Posted in CCG, Commissioning, Competition & cooperation, Contracting, Deputy Director of PRUComm, Director of PRUComm, Public Health, Seminar, Stephen Peckham
Tagged alliance contracting, CCG, CCGs, co-commissioning, commissioning, Competition, Contracting, Cooperation, England, FYFV, GP, HSCA2012, new care model, new models of care, NHS, planning, policy, policy-making, primary care, PRUComm, Public Health, QOF, Quality, STP
This report is part of the research of the Policy Research Unit in Commissioning and the Health Care System (PRUComm) on new models of contracting in the NHS, commissioned by the Department of Health.
Over the past few years the need to find new ways to integrate services has become an important policy priority in the English NHS. The formation of new organisational configurations in local health economies announced in the Five Year Forward View entails separate organisations working closely together to improve the integration of local services and allow the better use of resources. One way to achieve collaboration across organisational boundaries is through the adoption of new models of contracting, such as alliance contracting, prime provider contracting and outcome based contracting. Despite their relative novelty in the English NHS, these models have a history of use in other sectors such as construction and defence, as well as in the commissioning of public services in the UK and overseas.
This report summarises the findings of a literature review of the available evidence concerning the characteristics of these new contractual models and their implementation in other sectors. The available evidence is considered in order to draw out the lessons which may be learnt to aid the implementation of these models in the English NHS.
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