CCGs to use primary care powers to develop new care models

NHS England last week announced that 64 CCGs had been approved to take on delegated commissioning of primary care in 2015-16. One further group has conditional approval.

Helen Hirst, chief officer for Bradford City and Bradford Districts CCGs, which were both approved, told HSJ they would now have “more flexibility” when redesigning services around the new models of care.

It will enable the two CCGs “to look at the primary care resources in the context of all our other resources locally”, she added.  

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West Leicestershire CCG chair Mayur Lakhani said the new powers would be a “mechanism to bring more resource into primary care over and above the core contract”, and allow CCGs to develop federations of GP practices. His CCG has “some ideas already” on using locally negotiated alternative provider medical services contracts “to commission more services for primary care in federations”.

West Leicestershire has a five year primary care plan in which GP practices will be “the locus of control for population health and holding the system together… working together at scale in federations of about 90,000”, providing extended services such as ear, nose and throat services, dermatology and ophthalmology.

Birmingham CrossCity CCG chair Gavin Ralston said: “There’s been talk for a number of years about changes in general practice [around working at scale], but they seem to be coming very rapidly now.”

He said there were still many small and single handed practices operating under a “corner shop” model in Birmingham, and, with delegated responsibilities, CCGs will be “well placed [to] facilitate general practice to make the necessary changes to form corporate partnerships or robust federations”.

It was also an “opportunity to join up the system more closely between primary and secondary care”, Dr Ralston said, describing the current system as “commissioning with one hand tied behind your back”.

HSJ revealed last month had applied to NHS England to take on delegated commissioning of primary care. Twelve were not approved (hsj.co.uk/ccgs-primary-care).

Slough CCG applied for full delegation but, following feedback from NHS England about the “uncertainty associated with [its] present interim management structure”, it scaled down its ambition, instead opting to jointly commission primary care with NHS England.

Great Yarmouth and Waveney CCG’s application was not approved because of its financial challenges and reluctance to take on additional cost pressures.

Eight north west London CCGs jointly submitted an application for delegated commissioning but, following a review by a regional moderation panel, they did not have enough time to make changes to their application NHS England required.

Stoke on Trent and North Staffordshire CCGs also unsuccessfully bid for delegated commissioning.

NHS England confirmed to HSJ that applications were “assessed against a range of robust criteria”, including whether they posed any “capability or capacity challenges” for CCGs.

The financial requirements of delegation were also reviewed alongside the CCG’s current and planned financial performance, and business rules compliance.

An NHS England spokeswoman said it was “not our expectation at this stage that all CCGs nationally will assume delegated responsibilities”.