How engaged are CCG members one year on?

One year ago today, clinical commissioning groups (CCGs) formally took on their statutory responsibility for £65 billion of the NHS budget. And just over two years ago, The King’s Fund and Nuffield Trust began its joint research programme following the evolution of clinical commissioning in six CCGs. We’re particularly interested in finding out how these organisations are supporting improvement in the quality of general practice.

The engagement, interest and buy-in of GPs is essential to the success of CCGs. CCGs are different to the primary care trusts that went before them because they are designed as membership organisations in which GPs are given a genuine opportunity to influence decision-making about local health service provision. NHS England’s recent Call to Action on improving general practice also pointed to CCGs having a valuable opportunity to use their clinical leadership skills and relationships with member practices to help ‘transform primary care’.

Our first year findings highlighted a sense of goodwill and optimism about GP-led commissioning, and almost three-quarters of survey respondents felt engaged in the work of their CCG. But it was also clear there was a limited window of opportunity to harness and build on that level of enthusiasm.

So how do individuals in CCGs feel about engagement one year on?

The results of our second survey are published today and tell us that:

• overall there has been no increase or decrease in how engaged respondents feel in the work of the CCG – although fewer GPs reported feeling ‘highly engaged’ in CCG work this year

• GPs with no formal role in the CCG remain less engaged and involved

• more GPs report having influence over the work of the CCG than they did over the work of the PCT in the past.

How engaged do you feel in the work of the CCG?

Influence over the work of the CCG/PCT

Less than half of the respondents felt they could influence the work of the CCG if they chose to. Realistically, we know it won’t be possible for all member GPs take on active roles in the CCG, but it is vital to create a culture that encourages and facilitates GPs’ involvement in commissioning.

One CCG chief executive said to me recently that CCGs are at a ‘tipping point’ for engagement; a concerted effort could be made to increase engagement, or engagement could tail off due to a range of factors, including lack of time, dissatisfaction with payment and working conditions, difficulty in changing entrenched behaviours, mergers of CCGs and whether the encouragement to work in a federated model is welcomed by those who are used to working as independent contractors.

CCG leaders could keep up the momentum by giving GPs meaningful involvement in commissioning decisions and promoting CCG success stories of primary care projects that have improved the care of patients and made GPs’ working lives easier. They could also increase engagement by drawing younger GPs into the work of the group – something that is vital for the long-term sustainability of the organisations.

One year since they took on their statutory responsibility, CCGs have done well to maintain levels of engagement. This is a reason to be optimistic.

We will be exploring and reporting on how engagement evolves in our sample of CCGs over the next year and will publish a report based on what we have found so far in the autumn.

In the meantime, happy anniversary, CCGs.