Clinical commissioning: GPs in charge?

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Part of The evolution of clinical commissioning

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.


Dr Andrew Tresidder

GP Patient Safety Lead,
Somerset CCG
Comment date
19 July 2016
excellent and timely report
Thinking of leadership, and the vital quality of compassion needed, Paquita de Zulueta's Compassionate Leadership in Healthcare 2016 is an excellent read . This identifies qualities of organisation and development needed, and this article could usefully be read by all leaders serious about wanting the best for patients

Mark Rickenbach

GP and Visiting Professor of Healthcare and Education Innovation,
Park and St Francis surgery, Winchester University
Comment date
14 July 2016
I have seen significant improvements in care taking place and these are much more clinically focused than in the past. However, GP leaders have to take care to retain their clinical and patient focus. There is a risk that GPs become divorced from day to day practice as managers and focus more on rationing and organisational change at the expense of this focus on integration, clinical care and patients. The success is getting the balance and keeping grounded in the reality of patient care.

Gurch Randhawa

Director, institute for health research,
University of Bedfordshire
Comment date
14 July 2016
Timely report! GPs are between a rock and hard place, they need more time and resource to become effective and commissioners, and more time and resource to meet the increasing patient activity in primary care! Houdini for Health Secretary?

John Kapp

Social Enterporise Complementary therapy ~company SECTCo
Comment date
13 July 2016
Good report, which accords with my experience campaigning for a cure to the crisis in primary care by commissioning more NICE recommended talking therapies under IAPT to teach patients self care, so they don't need so much public services, (such as the 8 week Mindfulness Based Cognitive Therapy (MBCT) course. MBCT is 100 times more cost effective than 121 CBT as one teacher can 'treat' 15 patients, who get peer support to combat isolation. This is the key new provider model needed, which allows GPs to revert to their original duty as teachers (the word doctor comes from 'doctare' which is latin for 'to teach'.

Dr Umesh Prabhu

Medical Director,
Wrightington, Wigan and Leigh FT
Comment date
12 July 2016
Well said and it is all about good leadership. NHS has many leaders but it is still short of good leaders be it commissioning or providers. It is also true that NHS works in silos with too many organisations and too many leaders. In such a system and culture patients and staff suffer as many leaders focus on finance and targets without even realising how much money is wasted in the bureaucracy.

It is not the quantity of leaders that matters but the quality of leaders. Good leaders are those who take responsibility and stop blaming others. They create a culture, systems, processes by working with everyone to make sure all patients get the best and safe care and there is excellent governance and accountability for all.

World class commissioning or World class provider service is possible if only we have World class leaders who all work for a common purpose and that is our patients. Leaders are simply servants of people of this country and their aim is only to provide the safest and the best care for everyone.

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