Clinical commissioning groups: Supporting improvement in general practice?

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Part of The evolution of clinical commissioning

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


M Clark

Comment date
09 October 2014
A local treatment centre has been providing sub-standard treatment for over 8 years despite the Trust concerned being told to update. It has ended up being the only centre in the SW (and probably the country)_ not providing up to date treatment. Complaints to the DoH are referred to the Trust who reply with the same excuses they have been making for 8 years. There is seemingly no-one in overall control who can check what is being provided for taxpayers' money. During that time the Trust has spent money on many non-essentials (£10,000 for a small piece of customised wallpaper for its entrance foyer!!!). A review was done at huge expense following complaints which found what patients had been saying all along. Rather than any action, another review is being spoken of - anything in fact but action. The facility is NHS but this is irrelevant - whether NHS or privately provided there needs to be an independent body (containing professionals with adequate knowledge of what they are dealing with) that can check just what is being provided. A private provider has said it could have a unit up and running in months with treatment costs less. In the meantime patients continue to receive sub-standard treatment.

MR Richard Harris

Comment date
14 June 2014
having had acupuncture for the last few years because of failed lower spine surgery ,I have now been told I can't have no more sessions because of CCG policies. I have been given a number of different medications which I have had bad side affects Had epidurals etc. did not help. Acupuncture had no side affects, lowered my blood pressure, helped a lot with the muscle spasms and most important helped me sleep and gave me a purpose in life. My pain clinic Dr tells me it is one of the cheapest. Find something that really helps then told CCG policies will not allow it. I find this very distressing and worrying what my life is going to be from now on without Acupuncture.


Digital Communications Manager,
The King's Fund
Comment date
03 April 2014
Hi Nasreen, thank you for your comment. Bluecare Luton is not one of the case studies in this publication so we cannot help with your inquiry. However, we would suggest contacting Luton Social Care services for any queries.



Nasreen Imtiaz

Asian Welfare Association of Luton
Comment date
03 April 2014
I am interested to know Bluecare Luton. Who is funding this company. Are there trained care workers. As for I am concerened that they have not fully trained worker. The worker are even not educated. They can not speak or write English. This is important to have fully trained care worker to handle specially old and ill person. I have visited them and I have found that they are not fully qualified. I am surprised how they have got funds. Please feed back to me about this company.


Comment date
19 January 2014
Hello Everybody,
Allow Me To Introduce Myself To You All My Name Is Sara And I am An Adult With Autism, And Chair Of My Local Autism Partnership Board Here In Grimsby North East Lincolnshire, And An Officially Trained Champion For All Those On The Autistic Spectrum Here In Grimsby North East Lincolnshire,
We Now Have A Partnership With Humberside Fire And Rescue Service On Both Sides of The River Humber Here In Grimsby North East Lincolnshire. Who We Have Now Trained Up On Autism On A Voluntry Basis, We Have Also Won Community Awards Through Humberside Fire And Rescue Service Hull, For All Our Autism Awareness Training Sessions We Have Now Done With Them, As Well As Continuing To Do On Going Autism Projects With them.

Shirley and Pa…

Comment date
13 December 2013
Please do not close Holly Hall clinic in Dudley. My disabled husband has been taken ill twice recently, both times at the weekend and while not needing A&E has needed urgent antibiotics. The clinic has been ideal.

S.M.Bough Kingswinford

Julie Forshaw

Clinical Risk Manager,
Mid Yorkshire Hospitals NHS Trust
Comment date
02 December 2013

Would you let me konw if there is any analysis completed on the amount of SI's that Trusts are reporting. This would enable Trusts to benchmark against other Trusts who are a similar size to themselvesi.e. as we are a large acute Trust it would be valuable to benchmark on how many SI's other trusts are reporting on an annual basis?

Kind regards


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