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Clinical commissioning: GPs in charge?


Clinically led approaches to planning and designing health services are more likely to be both innovative and effective. For this reason, clinical commissioning groups (CCGs) were set up to put GPs at the heart of NHS planning decisions. What progress have CCGs made in implementing their clinically led model and what more needs to be done?

This report looks at what has been learnt – including strategies to overcome challenges and identification of the main barriers to effective involvement – and makes recommendations for the future. Its findings about clinical involvement are relevant not only to policy-makers and CCGs but also to other organisations across the NHS involved in planning and designing services.

Key findings

  • Effective clinical involvement and clinical leadership are essential for high-quality commissioning.

  • CCGs have achieved better GP engagement than previous forms of commissioning.

  • CCGs have faced significant challenges in embedding clinical involvement in commissioning and have developed a range of strategies to overcome these. The challenges include: engaging with all GPs in a local area; developing the next generation of GP leaders; managing conflicts of interest; and using links with GPs to improve the quality of general practice locally.

  • CCGs identified three national barriers that are inhibiting effective clinical involvement: lack of autonomy to take decisions that meet local needs; budget and resource constraints; lack of support for tough prioritisation decisions.

  • There are clear steps that NHS England and the Department of Health need to take to build on what CCGs have learnt, address the continuing barriers and embed clinical involvement in planning decisions across the NHS.

Policy implications

  • NHS England must publish a vision for the future of NHS commissioning that recognises the overlapping planning and delivery structures that are developing across the country, and reaffirms the principle of clinicians being at the heart of planning decisions, wherever those decisions happen in the NHS.

  • Commissioning needs to be promoted as a rewarding career option for clinicians and clinical leaders need to have access to the developmental support and training they need to do the job properly.

  • Lessons should be learnt from the primary care co-commissioning process before transferring further commissioning responsibilities to CCGs.