New research into the early development of clinical commissioning groups (CCGs), a cornerstone of the coalition government's NHS reforms, suggests that many GPs do not currently have a strong sense of ownership of their local CCGs.
A distinctive feature of the 211 CCGs that took over responsibility for the majority of the budget for commissioning health care services in the English NHS from 1 April 2013 is that they are membership organisations designed to harness the clinical expertise of their local GP members. Handing greater control of budgets to GPs was a key element of the government's Health and Social Care Act (2012).
However, one of the first studies to be conducted into the early experiences of CCGs, published today by The King's Fund and the Nuffield Trust, suggests that member GPs are less likely to believe that their CCG is 'owned' by them when compared with the leaders of those CCGs. While there was a great deal of support for what CCGs are trying to achieve, many of the GPs involved in the study felt that decisions being taken by their CCG did not always reflect their views.
The report, based on six case study CCGs, highlights significant variation between different CCGs, with levels of member ownership and involvement much higher in some areas than others. Larger CCGs in particular may face a challenge in engaging GPs and creating a culture of collective ownership.
The research also found that most GPs believe CCGs have a legitimate role to play in trying to influence the clinical behaviour of local GPs, but there is some wariness of the form which this will take. It remains unclear how responsibilities for primary care development will be divided between CCGs and the new national commissioning board, NHS England, and the report recommends that this should be clarified.
'CCGs have a real opportunity to get clinical expertise into the heart of decision-making. Our research suggest that there is a lot of goodwill in general practice towards CCGs and there is a general wish for CCGs to succeed. It is important that CCGs seize the opportunity to build on these positive first signs of engagement and develop strong relationships with their membership, so that they can help general practice evolve and respond to changing needs.'
Holly Holder, Fellow in Health Policy at the Nuffield Trust said:
'There is a great deal of support for what clinical commissioning groups are trying to achieve: to become locally driven decision-making bodies that provide better care for their populations. However, in order to reach that goal, CCGs will have to sustain the support of their membership and demonstrate how participation from local GPs adds real value to their work. CCG leaders should know which areas of clinical practice GPs perceive to be legitimate spaces for CCGs to influence, and which strategies could risk disengagement.'
The research is the first report from a three-year joint project by The King's Fund and the Nuffield Trust that will examine how clinical commissioning is evolving in the new health care system.
Today's report argues that CCGs will need to strike a careful balance if they want to influence primary care practice without alienating their GP members, on whom they depend for their legitimacy. There is a clear danger of repeating the same mistakes as previous attempts at clinical commissioning if CCGs fail to bring about service changes that win the support of their member within an acceptable timeframe.
The Nuffield Trust and The King's Fund are therefore calling for CCGs to prioritise strengthening connections with members and using these relationships to help shape and improve GP services locally. CCGs should focus on:
- creating a governance structure that supports the involvement of local clinicians in decision-making and delegates power where appropriate
- clarifying the relative roles of member councils, locality groups and the governing body, and ensuring that those involved understand what authority and responsibilities sit at each level
- articulating the role of the CCG in supporting quality improvement in primary care, explaining where this role begins and ends, and how the CCG will work with the NHS England local area team
- supporting peer-to-peer dialogue and performance review in small groups, particularly through face-to-face meetings
- ensuring that members understand the most important elements of the CCG’s constitution
- communicating a vision for the CCG that describes how it is distinct from previous commissioning organisations, such as primary care trusts.
Read the first report: Clinical commissioning groups: Supporting improvement in general practice?
Notes to editors:
For further information, or to request an interview, please contact the Press and Public Affairs office at The King's Fund on 020 7307 2585/82 (if you are calling out of hours, please ring 07584 146 035).
The report, Clinical commissioning groups: supporting improvement in general practice?, will be available at: www.kingsfund.org.uk/clinicalcommissioning
The report is part of The evolution of clinical commissioning: learning from local experience project that aims to understand the development of CCGs and the challenges they face. The project began in November 2012 and will continue until 2015, with an interim report each year detailing findings to date.
In subsequent years, the project will explore how clinical commissioning groups implement their responsibility to support improvement in general practice and the involvement of member GPs in commissioning activities. A key line of inquiry throughout the project is the extent to which new clinical commissioners differ from previous forms of commissioning organisation (principally primary care trusts) and whether they are likely to be more or less effective in bringing about changes to local health services.
Clinical commissioning groups (CCGs) are one of the centrepieces of the government's NHS reform programme. These new GP-led groups control the majority of the NHS budget and have the task of using this money to improve health services in their local area. The success of the reforms rests largely upon these new organisations being able to make significant changes that improve the quality and productivity of care.
The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.
The Nuffield Trust is an authoritative and independent source of evidence-based research and policy analysis for improving health care. Our vision is to provide objective research and analysis that boosts the quality of health policy and practice, and ultimately improves the health and health care of people in the United Kingdom.