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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.

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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.”


NHS Commissioning Board summary findings

Authorisation by region   
 Total CCGsNumber authorisedNumber of conditions
Midlands and East611133


Which areas are weak? 
Authorisation domainNumber of conditions
Clear and credible finance and service plans29
Constitutional and governance arrangements15
Strong clinical and multi-professional focus7
Engagement with patients, carers and communities5
Collaborative plans and commissioning support4
Great leaders4

Out come by CCG

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.

Readers' comments (6)

  • Richard Russell

    What does "Decision sign off or approval by the NHS CB" mean?

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  • Clear and credible plans weakest bit by a mile - all focus has been on putting in place structures and processes (which were all in place already under PCTs) but as far as actually doing anything service-related which is remotely convincing and will help to plug the financial black hole there's a yawning chasm.......

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  • Whenever I read the word 'toolkit' in NHS lingo, my eyes glaze over. They are kits for tools.......

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  • So we're a little over 3 months away from the CCG big bang, and only 16% of organisations have gone through an authorisation process which even the people being authorised seem to think is inadequate to truely assess their ability to manage their local health economy. And despite these inadequacies in the process about 75% of that 16% have only got through it with conditions attached. That's going well isn't it?

    Mind you, it's reassuring to see that most of the ones assessed so far have managed to find themselves "great leaders", although slightly confusing when we've been told previously that most of these organisations are headed up by much the same people that headed up the PCT's, (who I'm pretty sure were supposed to be self-serving, out of touch, fat cat bureaucrats).

    Oh and Richard that option means exactly as it reads ; effectively if the CCG is judged not competent enough to make significant decisions and then they all have to be rubber stamped by the local office of the Commissioning Board.

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  • I just hope the scrutiny process is more robust than some of the legacy documents that are doing the rounds (at least one contains chapters of which JK Rowling would be proud).

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  • A fantastic mind-boggling farce. It really looks more and more insane with every week. Exactly what happened to the BBC under John Birt. Are there real people [as opposed to DH fantasists] who believe in all this? What is wrong with everyone? As Dr Phil Hammond so eloquently told Andrew Lansley on Question Time (about the HSC Bill): 'It's 353 pages of wonk. It's impossible to understand it.'

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