A review of the role and costs of clinical commissioning groups

A review of the role and costs of clinical commissioning groups | National Audit Office

This review sets out:

  • changes to the commissioning landscape before CCGs were established
  • the role, running costs and performance of CCGs
  • the changing commissioning landscape and the future role of CCGs

The report identifies the importance of creating stable and effective organisations during the current restructuring of CCGs and that NHS commissioning needs a prolonged period of organisational stability to allow organisations to focus on transforming and integrating health and care services rather than on reorganising themselves.


Equality and Health Inequalities packs 2018

NHS England has published Equality and Health Inequalities RightCare packs for Clinical Commissioning Groups (CCGs).  The packs consider measures of health inequality and aims to support CCGs and health systems to identify areas of improvement in promoting equality and reducing health inequalities. Previously such analysis has not been available at CCG level.  Packs are available for each CCG in the following areas:

Equality and Health Inequalities Pack:  NHS Rotherham CCG

Driving forward system working

NHS Providers | December 2018 | Driving forward system working: a snapshot of  early progress in collaborative commissioning 

A report,  Driving Forward System Working, commissioned by both NHSCC (NHS Clinical Commissioners)  and NHS Providers, explores emerging practice in systems that are rethinking the way in which they plan and design services at a local level to support the delivery of joined-up and sustainable care. It revisits views from leaders in CCGs, providers, national bodies and think tanks about the concept of strategic commissioning, particularly as CCGs are increasingly working together to focus on outcomes across larger geographies and reduce management costs. It also explores views about the likelihood that providers will take on more of the activities that NHS England (as a direct commissioner) or CCGs currently undertake – be that to help develop service specifications or lead on pathway redesign.

The report considers:

  • Commissioning arrangements
  • Enabling collaboration
  • Areas of divided opinion


Contributors to the report identified the following areas key areas for systems to consider which can either enable or impede the evolution of local commissioning models.

  • Strong leadership
  • A ‘bottom-up’ approach
  • Involving all system partners
  • One version of the truth
  • Supporting the workforce
  • Governance and accountability
  • Regulatory behaviour
  • Contractual mechanisms
  • Previous system failures
  • Legislation

(Source: NHS Clinical Commissioners )

Ways of integrating care that better coordinate services may benefit patients

NIHR | December 2018 | Ways of integrating care that better coordinate services may benefit patients

In one of its latest Signals, the NIHR highlights a systematic review identified 267 pieces of literature from the UK and countries with a comparable economy, all published from 2006onwards, which analysed and described new models of integrated care. 

The review- funded by the NIHR-  looked at the international literature to understand how new care models may affect patients, providers and systems. Almost half of the 267 studies came from the UK. Most investigated integrated care pathways, often as part of a multicomponent intervention including multidisciplinary teams and some form of case management. Most studies focused on older people.



The review finds some positives, but overall highlights the complexity of implementing and assessing new models of care. The reviewers found the complexity and variability of interventions across the literature, a hindrance in understanding the effect of specific changes. Most studies were at risk of bias, with few comparison studies as these are often not appropriate for organisational research (Source: NIHR).

Read the NIHR Signal in full here 

Published abstract here



Home care in England: views from commissioners and providers

The King’s Fund | December 2018 | Home care in England: views from commissioners and providers

In the period between 2016 and 2018, The King’s Fund carried out three pieces of research exploring:

  1. the factors driving commissioning adult social care; the mechanisms of purchasing and delivery of home care;
  2. alternatives to traditional models of delivering care at home.

This research forms the basis of a new report: Home care in England: views from commissioners and providers, unites the findings of those research projects, which record the stated opinions of commissioners, providers and other stakeholders.


Key points:

  • Recruitment and retention of home care staff remains a fundamental challenge for providers, but the extent of the challenge varies greatly depending on geographical location
  • Most councils commissioning home care attempted to drive down the fees they pay. Commissioners and providers disagreed about whether quality of home care had declined  in recent years and, if it had, the role of fees in that process.
  • Home care continues to be commissioned on a ‘time and task’ basis rather than with a view to health  and care outcomes. Nor is there much evidence that health and care providers are joining up commissioning of home care.
  • Alternative approaches to home care provision  have yet to demonstrate they can be scaled up effectively, while approaches using new technology have not yet had time to be properly evaluated. (Source: The King’s Fund)

Download summary (PDF)

Download report (PDF)

See also:

The King’s Fund [press release]  Relentless staff shortage leaves home care sector struggling

The three pieces of research mentioned are:

 Adult social care: local authority commissioning behaviours

Understanding domiciliary care in England

New models of home care

All three are available from The King’s Fund 

Understanding the new commissioning system in England

The University of Manchester & London School of Hygiene & Tropical Medicine | December 2018 |Understanding the new commissioning system in England

The new report from PRUComm (Policy Research Unit Commissioning and the Healthcare System) sought to explore:

  • The new system at local level, investigating how the new organisations were developing, assuming their responsibilities, interacting, holding one another to account, and relating to new national-level bodies.
  • The main effects of the new system, seeking to demonstrate the changes that may be associated with elements of this system, as well as explicating factors which may have enabled or inhibited these changes.

The report is focused on three topics

  • Understanding system complexity
  • The conduct of commissioning
  • Quality and outcomes

Executive summary 

Full report 


Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

NHS England | November 2018 | Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

NHS England are running a national consultation on items which should not routinely be prescribed in primary care (for example GP practices, pharmacies, the dentist, and 
eye clinics.) The consultation involves 9 medicines and products. According to NHS England, research shows that some medicines can be replaced with other medicines that
work better, are safer or cost less money.


Overview Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

Easy read version of the consultation document

Consultation document 

See also:

NHS Clinical Commissioners [press release]