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The evolution of clinical commissioning: learning from local experience

Clinical commissioning groups (CCGs) are one of the centrepieces of the government's NHS reform programme. These 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 worked together to understand the development of CCGs and the challenges they face. As part of a major national research study, we followed the evolution of clinical commissioning in six case study sites. We hope the findings will be used to support CCGs across England by spreading good practice and learning.

Project content

  • Clinical commissioning: GPs in charge?

    What progress has been made around effective GP involvement in commissioning? This report from The King's Fund and the Nuffield Trust assesses what has been learnt so far and makes recom...

  • Risk or reward? The changing role of CCGs in general practice

    A report from the Nuffield Trust and The King’s Fund finds that CCGs risk becoming unsustainable without changes to the way they attract leaders and adequate funding to help them expand ...

  • Clinical commissioning groups: Supporting improvement in general practice?

    The King's Fund and the Nuffield Trust are working together to assess the implementation and impact of CCGs. This first report provides an overview of developments through to March 2013.

  • How engaged are CCG members one year on?

    One year ago today, clinical commissioning groups formally took on their statutory responsibility for £65 billion of the NHS budget. So how do individuals in CCGs feel about engagement n...

Project content

  • The best of times, the worst of times: a personal view from the CCG front line

    What are some the challenges currently facing CCGs? John Richards, Chief Officer of NHS Southampton City CCG, shares his thoughts.

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

    Co-commissioning has arrived. Today 64 CCGs take on fully delegated responsibility for commissioning general practice, while 87 CCGs take on joint commissioning responsibilities working ...

  • Co-commissioning one year on: any progress?

    How are new co-commissioning arrangements progressing, a year after their introduction? Chris Naylor considers the results of our survey of GP practices in six clinical commissioning gro...

  • Put GPs at the centre of the NHS commissioning roadmap

    Ruth Robertson outlines the importance of involving GPs in commissioning and planning in the NHS if we are to meet the challenges of transforming care and balancing finances.

What did we do as part of this work?

This project began in September 2012 and sought to understand the emerging relationships, structures and governance processes inside CCGs, with a particular focus on their growing role in primary care commissioning. 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 explored how this is unfolding in practice in six case study CCGs – 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.

Since April 2015, CCGs have had the option to take on new primary care commissioning functions that were previously the responsibility of NHS England (‘co-commissioning’). As part of this project, we considered how this policy development is affecting the work CCGs are undertaking to develop primary care services locally.


Has clinical commissioning found its voice? GP perspectives on their CCGs

This slide set presents the results of our fourth annual online survey of GPs and practice managers' views of their clinical commissioning group (CCG) and its role in primary care.

The survey was conducted by the Nuffield Trust and The King’s Fund as part of a three year project, looking to understand how the clinical commissioning groups at the heart of the NHS reforms are developing.

Primary care co-commissioning: a survey of members’ views of their CCG and its role in primary care

This slidepack outlines findings from our survey of GPs and practice managers that was conducted in early 2015, as part of the third phase of the project.

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