Just under a third of CCGs have seized the opportunity to take on extra duties through co-commissioning but it’s not without its challenges
Earlier this year NHS England approved the first set of GP-led clinical commissioning groups (CCGs) due to take on responsibility for commissioning the majority of GP services from April.
Sixty-four CCGs across the country have been approved with the possibility that others may follow. This follows plans set out by NHS England chief executive Simon Stevens, early last year, which aim to give patients, communities and clinicians more scope in deciding how local services are developed.
Dr Amanda Doyle, primary care co-commissioning programme oversight group co-chair and chief clinical officer for NHS Blackpool CCG – one of the organisations taking on delegated commissioning –believes that the plans will mean that local commissioning arrangements will develop across the country to deliver “the kind of integrated care, in and out of hospital that we all want to see”.
“Giving GP-led clinical commissioning groups more influence over the wider NHS budget, will enable a shift in investment from acute to primary and community services and to enable money to follow the patient. The introduction of co-commissioning is another strong step on the path to provide a more joined up, high-quality service for the future,” she says.
According to Ian Dodge, national director for commissioning strategy at NHS England the move is a “vote of confidence in CCGs”.
“It is part of our commitment to deliver a new deal for primary care. And it’s a critical step towards joining up the commissioning system, which in turn will help unlock new models of integrated care described in the NHS Five Year Forward View.”
Although primary care is currently commissioned by NHS England’s area teams, Stevens announced last spring that he wanted to hand the responsibility to CCGs. They were asked late last year to choose between three levels of co-commissioning: delegated commissioning, joint commissioning or greater involvement.
When the scheme was first announced nearly 200 CCGs said they wanted to take an active role in commissioning. Of those 64 chose to go down the route of completely delegated powers.
CCGs could also choose to continue as they are with no decision making power over primary care. NHS England has said that CCGs will be able to move up the different commissioning levels at a future date if they want to.
Those CCGs that take on ‘delegated’ responsibility from NHS England will also take on the responsibility of commissioning general medical services.
For CCGs that have yet to be approved, NHS England has said that it will continue to provide support to help them achieve the commissioning model that works best for them.
The move by NHS England follows the plan set out in the Next steps towards primary care co-commissioning document developed by the joint CCG and NHS England primary care co-commissioning programme oversight group in partnership with NHS Clinical Commissioners (NHSCC), and is aimed at delivering the wider strategic agenda set out in the Five Year Forward View.
While most CCGs have said they do want some level of involvement, there are still some concerns. Julie Wood, director of NHSCC, raised concerns about conflicts of interest. She said: “In commissioning arrangements, CCGs are taking all of the decisions for commissioning of primary care on a delegated basis and this makes it open to potential conflicts of interest.” However, she added that the issue is not new to the NHS and that CCGs need to make sure that they are set up in a way that ensures they can manage this.
The funding around co-commissioning has also been raised as a concern, particulary in terms of CCGs aleardy reporting a deficit. Mike Dixon, chairman of the NHS Alliance and a GP at College Surgery in Cullompton, Devon, said: “CCGs are being asked to commission primary care on a lower budget than ever before. There is the problem of CCGs who are already in deficit being able to affectively take on primary care commissioning at a time when they are up against it, in terms of their commissioning of commuinty services. There will be very little leeway for primary care.”
For those CCGs taking on joint rather than delegated responsibility there will be an opportunity to create a pooled budget with the local area team.
Although at first the new co-commissioning powers will be limited to general practice, NHS England has suggested said that pharmacists and dentists could also be included in the future and that CCGs could take over the commissioning of these services.
For now, the first 64 CCGs will be watched with interest, but it remains to be seen whether they can deliver on their increased responsibilities.
Helen Mooney is a freelance health reporter.