Work is well under way in implementing Simon Stevens’s blueprint for a more integrated NHS, in which providers work together across sectors to deliver co-ordinated care for patients. However, clinical commissioning groups (CCGs) are still waiting for publication of a roadmap for the future of commissioning, which is now expected from NHS England in the autumn.
Those writing that strategy face a challenging task. The role that CCGs play in the NHS is changing, and commissioning-like work is now undertaken by what can be a confusing range of organisations and planning structures that often overlap.
Since their launch in 2013, CCGs have gained some new functions (most CCGs now commission general practice services, either alone or in partnership with NHS England) and have lost others. In some parts of the country and for some services, lead providers undertake the nuts and bolts of commissioning, co-ordinating care for a local population through a series of sub-contracts with others. At the same time, some important strategic planning decisions are now taken by groups of providers and commissioners, who are quite rightly working together to decide how services should be developed across sustainability and transformation plan footprints.
It’s clear that CCGs need to adapt to fit into this new system that emphasises co-operation more than competition, and in which the split between purchasing and provision is becoming increasingly blurred. We have argued in the past that to do this, CCGs need to become more strategic and operate over larger geographical areas.
The King’s Fund and the Nuffield Trust have been working with six CCGs since their pre-authorisation phase in 2012. A strong message from our research and that by many others is that if the NHS is to be a sustainable, effective and innovative service, then clinicians need to be fully involved in NHS planning decisions. This means building on what CCGs have learnt over their first few years in operation about involving GPs in their work and spreading that learning across the NHS, wherever commissioning and planning work takes place.
The Health and Social Care Act 2012 put GPs in the driving seat of NHS commissioning and – despite all of the controversy about those reforms – there was a clear logic behind this move. The average person sees their GP every two months, which means that GPs probably have a better understanding than anyone else of their local population’s health needs. They also hold the key to the implementation of many new initiatives necessary to move care out of hospital and closer to patients.
Our report, Clinical commissioning: GPs in charge?, highlights seven challenges that CCGs have faced while developing their clinically led model of commissioning, and shares effective strategies to overcome them. One example is the challenge of succession planning as CCGs struggle to find GPs interested in taking on commissioning roles. Developing a pipeline of effective, motivated GP leaders to work with CCGs and sit on their governing bodies is crucial if the GP voice is to remain at the heart of CCG decision-making. The challenge of finding GPs to fill these roles has intensified with the emergence of new GP provider organisations and federations who are also looking for GPs to take on leadership posts. Efforts are being made to improve succession planning. These include the development of new roles, such as a GP associate posts on governing bodies to give GPs a chance to gain board-level experience, and a fellowship programme that gives GPs experience of working on CCG projects for one day a week. The reasons given by GP leaders who participated in our research for getting involved in their CCG were compelling, and the NHS needs to harness that enthusiasm and promote commissioning as a rewarding and important career option for GPs in order to motivate and develop the next generation of GP leaders.
As NHS England clarifies its blueprint for the future of commissioning, clinicians must be at its heart. That means supporting CCGs to continue and build on their work with GP members and extending this to other clinicians working in the community. Importantly it also means ensuring GPs and other clinicians are at the forefront of the new emerging planning structures in the NHS. It is striking that only 5 of the 44 sustainability and transformation plan footprints in England have GP leaders from CCGs at their helm. GP involvement won’t solve the big issues being faced by the NHS at the moment, but without buy-in from this key clinical group the NHS will struggle to meet the dual challenge of transforming care outside hospital and balancing its finances.