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CCG leads demand control of primary care

CCG leads demand control of primary care


The structure of primary care commissioning is a “challenge” that must be overcome, clinical commissioning group (CCG) leads have told NHS England. 

An open letter addressed to Sir Malcolm Grant, chair of NHS England, from NHS Clinical Commissioners calls for more clarity over roles, responsibilities and accountabilities. 

In the survey that fuelled the letter, some CCG leads said they feel they are driving forward primary care, rather than NHS England. The leads have called for primary care commissioning to sit with CCGs in the future. 

Amanda Doyle, Co-Chair of the NHSCC Leadership Group and Chief Clinical Officer at NHS Blackpool CCG said: “Parity of esteem in the commissioning system will only come about when the system fully embraces mutual assurance.  Until this happens CCGs will continue to see the relationships being one way, with no requirement for NHS England to account for its activities with respect to commissioning primary care and specialised services.

“In the relationships CCG leads are developing with their Area Teams and the positive intent with which Area Teams are approaching their support and development role we see encouraging indications. It is vital that these positive signs become embedded across the country – a single system need to have the behaviours rooted in its culture and cannot rely solely on individual good working relationships, many of which are described in this report.” 

The current incarnation of the system is still “young”, but that the overwhelming majority of CCG leads are discontented with the way their relationship with NHS England is turning out. 

The report states: “Many CCG leads did not seem to have much interaction with specialised commissioning teams and they rarely reported a shared vision or collaborative approach. 

“More joint working was requested in order to tie the various commissioning strands together, with a shared vision that is aligned to local needs and takes into account the impact of specialised commissioning on CCGs.” 

'Fractured system'

Responses to the survey were received from 177 of the 211 CCGs in England. 

The majority of CCG leads (37%) did not agree that their relationship with the area team they work with for specialized commissioning enable them to do a good job. 

And a similar amount (38%) said their relationship with NHS England is not effective when working as a co-commissioner for primary care services. 

NHS Clinical Commissioners president Michael Dixon said: “Our report shows that the commissioning system is fractured in its construction and this is leading to silo commissioning and behaviours. The solution has to be joining things up with CCGs the centre of this process not NHS England. 

“This is not a pyramid with CCGs at the bottom of a commissioning hierarchy rather they are glue that can bring these things together and create the right balances and priorities. At a time when the NHS is under extreme pressure, it is vital that primary care commissioning is properly resourced and that CCGs are enabled to take a more proactive role in the commissioning of primary care. CCGs must be given both the responsibility and the resources they need to better join up commissioning of services for patients.” 

However, the report did show that in many areas CCGs and NHS England area teams are working together well, and cooperating to get things right. 

 Dr Dixon said: “There are clear indications of good working partnerships but it is not yet consistent and it is vital that across NHS England they work hard to bring up all area teams to the standard of the best.”


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