The report showcases a range of innovative case studies from across the country, which demonstrate the difference that clinically led commissioning is making. The projects focus on prevention and early diagnosis.
NHS England is committed to giving CCGs and NHS England in the regions practical support in gathering data, evidence and tools to help them transform the way care is delivered for their patients and populations.
NHS Right Care now sits within NHS England, and working with Public Health Englandwe are providing a suite of materials to support effective ‘commissioning for value’. This includes a range of comprehensive data packs and online tools.
The information in the packs will be of particular interest to CCG clinical and management leads with responsibility for finance, performance, improvement and health outcomes; to NHS England regional team leads; and to commissioning support teams who are helping CCGs with this work. A range of additional free support to accompany the data is set out within each pack.
Objective: The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be ‘bottom up’ with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged.
Design: Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures.
Setting/participants: In phase 1 of the study ( January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings.
Results: Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs.
Conclusions: The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a ‘membership’ organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of ‘membership’ raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning.
NHSCC has criticised the Care Quality Commission’s (CQC) proposals to substantially increase its fees for regulating general practice services, stating that this would be detrimental to services being provided for patients.
Responding to the regulator’s consultation on the fees increases, NHSCC raises concerns about the disproportionate financial burden this will place on general practice at a time when its members are looking to invest further in primary care in line with the Five Year Forward View. The NHSCC response also highlights and shares the concerns expressed by the Public Accounts Committee that the CQC has not yet demonstrated its value in driving quality improvement through regulating general practice in the way that it currently does.
NHSCC co-chair, and Chief Clinical Officer of NHS Blackpool CCG, Dr Amanda Doyle said:
“We are extremely concerned about the impact that the proposed CQC fee increases will have on the…
Large scale GP provider groups operating in 82 per cent of England’s CCG areas
There are 268 federations up and running, HSJ research suggests
It is estimated that these organisations cover 41 million patients
Despite the wide coverage of groups identified by HSJ, the analysis suggests there is large variation in the functions they carry out.
Information on functions was provided for 110 GP groups and no single function was shared across more than half. The most common, listed for 55 groups, was providing extended primary care, for example long term conditions treatment, urgent care or services for the frail elderly. Many CCGs provided no information on the functions of the GP groups in their area.
The graph below shows the most commonly identified functions.