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Clinical commissioning groups: Supporting improvement in general practice?


Clinical commissioning groups (CCGs) are a core part of the government's reforms to the health and social care system. In April 2013, they replaced primary care trusts as the commissioners of most services funded by the NHS in England. They now control around two-thirds of the NHS budget and have a legal duty to support quality improvement in general practice.

The King's Fund and the Nuffield Trust are working together to assess the implementation and impact of CCGs. Between 2012 and 2015, we are following the evolution of clinical commissioning in six case-study sites and will publish the findings annually.

This first report is based on fieldwork conducted before CCGs had become fully authorised. It provides an overview of developments through to March 2013, plus an assessment of the opportunities and challenges ahead.

Key findings

  • CCGs have an important opportunity to support improvement in general practice but will need to strike a careful balance if they are to perform this function without alienating their GP members.

  • There needs to be greater clarity on how responsibility for the development of primary care is to be shared between CCGs and NHS England area teams.

  • NHS England area teams will not have sufficient capacity to monitor or manage GPs' contracts closely and will need to delegate some of their responsibilities to CCGs.

  • Levels of member ownership and involvement in CCGs are highly variable, and there are some significant disparities between the views of CCG leaders and member GPs.

  • There is a foundation of goodwill on which CCG leaders can build. Converting this into active support and engagement is one of the most pressing challenges ahead.

Policy implications

There is a limited window of opportunity within which CCGs will need to win the support of their local clinical community and demonstrate benefits to patients.

CCG leaders should prioritise building member relationships and cultivating a sense of collective ownership, including by:

  • creating a governance structure that supports the involvement of local clinicians in decision-making and delegates power where appropriate

  • clarifying the relative roles of member councils, locality groups and the governing body

  • supporting peer-to-peer dialogue and performance review

  • communicating a vision for the CCG that describes how it is distinct from previous commissioning organisations.

See also Appendix: survey of CCG member practices