Three quarters of first wave CCGs given authorisation 'conditions'
More than three-quarters of the clinical commissioning groups which passed the national test to take on budgets have had “conditions” imposed on their authorisation.
The NHS Commissioning Board announced the results of the first group, or wave, of 35 CCGs to go through its authorisation process on Tuesday.
Eight CCGs were fully authorised without any conditions; 26 were authorised with between one and 14 conditions and one deferred its application to a later wave. The commissioning board said many conditions were likely to have been be met and lifted in March, before CCGs take on full powers in April.
Each CCG was tested against 119 criteria by the commissioning board and if any was not met it was listed as a “condition”. For each condition, the CCG has been given a form of “support” to address it.
The support given to the 26 varies from level I - a “model document or toolkit” – to level III – “decision sign off or approval by the commissioning board”.
Nine were told some of their decisions would have to be signed off by the commissioning board. CCGs have been told to discuss how the conditions will be applied with board directors by 10 January, and to agree a “rectification plan”.
The requirements most commonly failed by CCGs include that they must have “clear and credible” operating and financial plans for next year and high level longer term plans (see box). Others included questions about their constitution or governance; quality and safety monitoring; and safeguarding.
Liverpool CCG deferred its application to the fourth and final wave after making a late-stage decision to host many more of its commissioning functions in-house, rather than contract them from a commissioning support unit.
Dame Barbara said she was pleased authorisation had been a “robust process” and seen as helpful by CCGs. She said: “CCGs mainly have minor conditions which we largely expect to be lifted by March. They are not unhappy about their conditions and understand the reasons [for them].”
She said: “We have gone through a process which has given CCGs the opportunity to demonstrate they meet 119 criteria which you would expect an autonomous organisation to do. If they are unable to, the board will inevitably want to have recourse.”
The board has not taken its most severe actions – which include sending in a team to help a CCG or removing its accountable officer – against any of the first wave CCGs.
The results of the remaining three authorisation waves – which include CCGs likely to have more serious problems – are expected between January and March.
NHS Confederation chief executive Mike Farrar, also a senior member of CCG representative group NHS Clinical Commissioners, said: “There was concern the authorisation process would be overly bureaucratic but CCGs have been very positive, and that augurs well for future relationships.
“Everybody knows how difficult it is going to be for CCGs [once they taken on control], but this is a positive sign of CCGs being ready.”
GP Peter Melton, accountable officer for North East Lincolnshire CCG, said he expected its five conditions to be lifted before April. He said the process had “helped to create a clear identity for these new organisations”. He said: “It has also helped secure wider ownership of the organisation and its business, particularly amongst its members. Having conditions is fine as it gives a clear signal about the process being transparent and rigorous.”
However the leader of a CCG in the Midlands which was authorised with conditions said he doubted the “consistency of the process”, and whether the same bar was applied to all groups.
He said: “I’m not sure what the authorisation process has achieved because it hasn’t touched on your ability to ability to operationally manage the local health system.”
|Authorisation by region|
|Total CCGs||Number authorised||Number of conditions|
|Midlands and East||61||11||33|
|Which areas are weak?|
|Authorisation domain||Number of conditions|
|Clear and credible finance and service plans||29|
|Constitutional and governance arrangements||15|
|Strong clinical and multi-professional focus||7|
|Engagement with patients, carers and communities||5|
|Collaborative plans and commissioning support||4|
Levels of support:
The seven support options are:
i. Model document or toolkit.
ii. Make advice or expertise available.
iii. Decision sign off or approval by the NHS CB.
iv. Insert or provide specific team or individual.
v. Accountable Officer (AO) not ratified or alternative AO appointed.
vi. Specific functions removed.
vii. All functions removed.