The evolution of clinical commissioning: learning from local experience

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Why were we doing work in this area?

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.

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.

Reports and slidepacks

Clinical commissioning: GPs in charge?

The final report from this project 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.

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.

You can also download the headline survey results:

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.

You can also download the headline survey results:  Primary care co-commissioning.

Risk or reward? The changing role of clinical commissioning groups in general practice

This report outlines findings from the second phase of our research, conducted in 2014. It aims to assist CCGs in making the transition to primary care co-commissioning by highlighting the potential risks and rewards of their new role.

Clinical commissioning groups: supporting improvements in general practice?

Our first phase findings are based on fieldwork conducted before CCGs had become fully authorised. The report provides an overview of developments through to March 2013, plus an assessment of the opportunities and challenges ahead.

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