Three things strike you immediately about the results of HSJ’s Barometer survey of clinical commissioning group leaders - the first to drill down into the hopes, fears and aspirations of this new cohort of NHS chiefs.

The first is their confidence that they can deliver change in short order. The second is how many of their priorities and concerns echo those of commissioning teams from past structures. The third striking finding is CCGs’ overwhelming enthusiasm for health and social care integration.

‘One message roars out of the survey: the belief that greater integration of health and social care services is the future’

CCGs are fired up by undergoing the authorisation process, specially designed to ignite ambition within the new leaders, and fresh from brainstorming their joint health and wellbeing strategies. There appears little doubt CCGs believe they can make “significant” improvements and changes in service patterns by this time next year.

Privately some CCG leaders admit to a level of naivety in their colleagues which only experience can cure. It is instructive that while 75 per cent of the CCG leaders surveyed claim to have a “good” or “very good” relationship with local hospital trusts, HSJ’s latest survey of hospital chief executives rated their relationships with CCGs at an average six out of 10.

Burning with energy to drive change

However, the key finding is that CCG leaders are still burning with energy and enthusiasm to drive change. This is welcome for there is much work to be done. But if CCG leaders are bringing a freshness to a somewhat jaded sector, they are also ironically singing the same laments that have echoed from commissioners for over a decade.

They are worried about: too much central control; the inappropriateness of payment by results; political opposition to service redesign; and having enough money to deliver quality care. As HSJ readers could have predicted, the reorganisation has not changed the fundamental problems facing the service.

This fact is also reflected in the similarity in priorities, noticeably controlling secondary demand. It will bring an ironic smile to the faces of primary care trust managers to see the great majority of CCG leaders back “bans or limits” on “treatments which are not clinically justified”.

Clinical “justification” is, of course, in the eye of the beholder and it will be interesting to see if the Daily Mail (and the health secretary) sees any difference when the argument is made by a CCG chair rather than a PCT medical director.

Swimming in a straitjacket

It is also clear how dissatisfied CCGs are with deep government cuts to management funding and support - singling it out as the number one barrier to their effectiveness and with one respondent likening it to “swimming in a straitjacket.”

But one message roars out of the survey: the belief that greater integration of health and social care services is the future. The professional role of GPs as an aid to good commissioning decisions is overplayed, but it seems likely the day-to-day experience of hearing patients’ frustrations with the health and social care divide has convinced many to take a whole system approach.

CCGs also do not appear to have the suspicion of local authorities that existed in many PCTs. Movement on this front now seems to have real momentum.

The determination to deliver joined-up care shines through in the support for greater use of the third sector and, of course, a wider range of GP provision.

Yet there is little interest in embracing the private sector. It would be wrong to suggest thatCCGs have rejected this approach outright - some still believe it has a tactical role and government advisers, during Andrew Lansley’s time at least, used to argue CCGs would soon learn the value and power of competition.

However, with one in three CCG leaders saying increased competition is a “significant barrier” to improvement, that moment of “enlightenment” seems some way off.

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