Cornerstone of NHS reforms faces uncertain future

Clinical commissioning groups (CCGs) have secured better engagement from GPs than previous forms of commissioning but still face numerous barriers to putting power in doctors’ hands, according to a new report published by The King’s Fund and the Nuffield Trust.

A survey of GPs and practice managers in six areas of the country, conducted annually since 2013, found that more than 70 per cent of CCG members were at least ‘somewhat’ engaged with the work of their CCG. This compares favourably with engagement levels under practice-based commissioning, the previous approach to involving GPs in commissioning that was implemented in 2005.

Despite the progress made, the report warns that CCGs’ clinically led model of commissioning is at risk if barriers to effective clinical involvement are not addressed. The research found that CCGs feel they need more autonomy to involve GPs in decisions about service design. There are also concerns that inadequate resourcing of CCGs is undermining efforts to develop high-quality, clinically led commissioning and that there is a lack political support when making tough decisions about priorities.

The report highlights concerns among GPs about their influence on commissioning decisions. In 2016 only 20 per cent of GPs without a formal role in their CCG reported that they could influence the work of their CCG if they chose to – down from 35 per cent in 2014. GPs felt that CCG managers still had more influence over commissioning decisions than GPs and that there had been little or no change in the quality of care in general practice as a result of their CCG.

The report, Clinical commissioning: GPs in charge?, is the culmination of a joint research project undertaken by The King’s Fund and the Nuffield Trust. Researchers followed six CCGs from their creation in 2012 to where they are today. The report aims to share learning from their experience about securing effective GP involvement in commissioning.

Ruth Robertson, Fellow in Health Policy at The King’s Fund, said: ‘Our research shows that while CCGs have made good progress in engaging GPs in local commissioning decisions, there remain significant barriers to effective clinical engagement and to translating this into improvements in quality of care.

‘The NHS must now build on CCGs’ achievements and do more to embed clinical involvement in planning decisions across the health care system. As well as properly supporting GP commissioners within CCGs, this means ensuring that GPs and other clinicians have a strong voice in the sustainability and transformation planning process and in the vanguards.

‘Engagement with GPs and other clinicians is crucial to efforts to transform out-of-hospital health and care provision and to move the NHS to a more financially sustainable position. In these challenging times for the health service, it is more important than ever that clinical engagement in commissioning decisions is properly supported.’

Holly Holder, Fellow in Policy at The Nuffield Trust, said: ‘Involving doctors and their colleagues in decisions about how NHS money is spent is very important. It won’t be possible to make the kind of changes at the front line we need to see without buy-in from people who actually deliver care.

‘We are now moving into a complicated world of multiple and overlapping organisations taking on some of the responsibilities that GP-led clinical commissioning groups were given in the 2012 reforms. This must not mean diluting the voice of GPs and alienating those who have contributed to CCGs over the past few years. We want to see national leaders say clearly that clinical commissioners will still have an important place in the future NHS. They must support CCGs to make taking part an attractive, rewarding career path for GPs – which we know it sometimes is not.’