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Co-commissioning: a new relationship between GPs and their CCG


Co-commissioning has arrived. Today 64 clinical commissioning groups (CCGs) take on fully delegated responsibility for commissioning general practice, while 87 CCGs take on joint commissioning responsibilities working with NHS England. That’s about 70 per cent of CCGs taking on a greater role in the commissioning of services from their member GP practices.

Up until now, CCGs have had a statutory duty to support quality improvement in primary care, but NHS England has been responsible for commissioning duties. From today, CCGs that take on fully delegated co-commissioning responsibilities will be responsible for – among other things – commissioning general medical services, including performance management of the GP contract, awarding new contracts, and renewing or varying existing ones.

This presents an exciting opportunity for CCGs to foster their close links with GPs and to use their expert knowledge to drive the changes in primary care, including developing the models set out in the NHS five year forward view. However, the new relationship this creates between the CCG and its membership will have to be carefully navigated if it is to deliver on its promises, as Holly Holder my co-investigator at the Nuffield Trust also outlines in her blog.

In January and February 2015 we surveyed GPs and practice managers in six CCGs to find out how they felt about co-commissioning and their CCG’s role in primary care. The results are published today, as part of an ongoing joint project by The King’s Fund and the Nuffield Trust.

Overall, more respondents in our survey felt positive rather than negative about co-commissioning. But perhaps unsurprisingly, the views of those closely involved with their CCG were quite different from other respondents. While 81 per cent of CCG governing body members felt positive about the policy, just 30 per cent of GPs and practice managers with no formal role in the CCG felt that way. Most of those with no formal role described their feelings as ‘neutral’ (43 per cent), indicating that they have yet to form a conclusion about the risks and rewards of co-commissioning.

Co-commissioning: how do you feel about this development?

Co-commissioning: a new relationship between GPs and their CCG

Getting those undecided members on board will be essential to the success of co-commissioning. CCGs were set up as membership organisations made up of GP practices. To implement major changes in primary care, each CCG will need to foster good relationships with its members, and between the practices that make up the CCG.

Many of the GPs we surveyed were positive about the impact that being part of a CCG had on their relationship with other practices (48 per cent) – more so than many of the other areas we asked them about (especially the amount of paper work and extra meeting commitments, where just 6 per cent reported a positive impact). Co-commissioning offers an opportunity to harness and develop this. The GPs we surveyed also supported the CCGs’ role in influencing primary care, with 83 per cent agreeing that the CCG has a legitimate role in influencing their prescribing patterns and 75 per cent agreeing that the CCG has a legitimate role in influencing their relationship with other practices.

However, our findings indicate that CCGs’ new performance-management role could prove unpopular among their members. When we asked GPs what mechanisms they felt the CCG should use to support improvement in primary care, the most popular were facilitating GP training and education (76 per cent in support of this) and encouraging practices to review comparative data (63 per cent). The least popular were harsher performance management tools. Only a quarter of the GPs we surveyed felt the CCG should set targets or objectives for practices and only 13 per cent felt that the CCG should use sanctions against underperforming practices.

Co-commissioning offers the opportunity to fully utilise the knowledge of GPs and build on the relationships that CCGs have developed. But CCGs will need to strike a careful balance when fulfilling their new responsibilities if they are to maintain the relationships that they have developed, which will be so key to their success.