The evolution of clinical commissioning: learning from local experience

Why are we doing work in this area?

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. CCGs are taking on this challenge at a time when the wider health and social care system is undergoing significant change and in a context of ever-tightening budgets.

In recognition of the importance of this issue, The King's Fund and the Nuffield Trust are working together to understand the development of CCGs and the challenges they face. As part of a major national research study, we are following the evolution of clinical commissioning in six case study sites. The findings will be used to support CCGs across England by spreading good practice and learning. 

What are we doing as part of this work?

The study began in September 2012 and will last for three years. In the first year, the work is focusing on understanding the emerging relationships, structures and governance processes inside CCGs. A distinctive and important feature of CCGs is that they are membership organisations designed to harness the clinical expertise of their GP members. Our research will explore how this is unfolding in practice – how members are involved in the CCG, what influence they have, and how CCG leaders and members are working together to change the shape of primary care services locally.

In subsequent phases, the project will explore how clinical commissioning groups work with other organisations in their local area, and most importantly, what impact they have on patients. 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.

Timings for this work

The project will continue until 2015, with an interim report each year describing findings to date. The first report is due for publication in summer 2013.

Main contacts for this piece of work

• Chris Naylor
• Shilpa Ross
• Natasha Curry (Nuffield Trust) 
• Holly Holder (Nuffield Trust)
• Louise Marshall (Nuffield Trust)