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CCGs face ‘significant barriers’ to improving care

Clinical commissioning groups (CCGs) have made improvements in engaging GPs in the commissioning process but still face barriers to using this to improve care, a new report has said.

The joint report from the King’s Fund and the Nuffield Trust says that the clinically led model of commissioning faces barriers because CCGs feel they are not being given the autonomy they need to involve GPs in decisions about commissioning services.

It says that financial pressures are also a problem, because reduced running-cost budgets and the transfer of new functions without sufficient additional resources means that CCGs are struggling to develop a high-quality clinically led commissioning function.

They also feel that they lack support from the government and NHS England in making tough prioritisation decisions.

Ruth Robertson, fellow in policy at the King’s Fund, said: “Our research shows that while CCGs have made good progress in engaging GPs in local commissioning decisions, there remain significant barriers to effective clinical engagement and to translating this into improvements in quality of care.”

The King’s Fund and the Nuffield Trust recommend that NHS England and the Department of Health should outline a clear strategy for the future of commissioning support that recognises the likely changes in CCGs’ support needs over the next few years, as the role of CCGs changes and provide them with ‘air cover’ for tough funding decisions by being honest with the public about what is achievable with the money available.

In addition, they should provide clinical leaders with the developmental support and training they need to do their job, set out clearly the role that CCGs can take in developing new models of care, and learn the lessons from the primary care co-commissioning process before transferring further commissioning responsibilities to CCGs.

The report also said that financial pressures on CCGs could be reduced by lifting the moratorium on voluntary mergers between CCGs, although compulsory mergers should be avoided.

The report also says that there is a risk of fragmentation in the commissioning process because of the multiple organisations involved, including vanguards and STPs.

Vision for the future

It says NHS England should publish a vision for the future of NHS commissioning that includes a core set of principles for the different organisations involved in the system, and make a statement reaffirming that clinicians are at the heart of the commissioning system.

The report suggests that structural changes to the commissioning system should be flexibly adapted to local conditions, and that commissioning organisations should have sufficient flexibility to make decisions that are in the best interests of patients.

It also says that NHS England must ensure that requirements for CCGs to manage conflicts of interest apply across the NHS, including in provider organisations that take on responsibilities for NHS procurement decisions.

Holly Holder, fellow in policy at the Nuffield Trust, said: “Involving doctors and their colleagues in decisions about how NHS money is spent is very important. It won’t be possible to make the kind of changes at the front line we need to see without buy-in from people who actually deliver care.

“We are now moving into a complicated world of multiple and overlapping organisations taking on some of the responsibilities that GP-led clinical commissioning groups were given in the 2012 reforms. This must not mean diluting the voice of GPs and alienating those who have contributed to CCGs over the past few years. We want to see national leaders say clearly that clinical commissioners will still have an important place in the future NHS. They must support CCGs to make taking part an attractive, rewarding career path for GPs – which we know it sometimes is not.”

Dr Amanda Doyle, co-chair of NHS Clinical Commissioners and chief clinical officer of NHS Blackpool CCG, said: “The King’s Fund and Nuffield Trust report rightly recognises the important role that clinical commissioners now play in the wider health system, and that they have matured and developed over the last three years bringing new and innovative approaches to better healthcare for their local populations.

“Their findings that CCGs have secured better clinical engagement from their wider membership than previous incarnations reflects what we’ve heard from our members. As a CCG leader and a GP myself I recognise the challenges and pressures that come with balancing both roles, and we know there is more to do to make sure even more GP colleagues and other clinicians feel able to actively participate in the clinical commissioning process.”

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