Although many CCGs are now up and running, they face a number of challenges that show no sign of abating. Ben Gowland discusses a key priority for his commissioning group.

As last year drew to a close, clinical commissioning groups were feeling the pressure. At Nene Commissioning we are frequently asked which, of all the challenges we face, is our number one priority?

It is a tough one because there are a number of worthy contenders. For many aspiring CCGs, achieving authorisation is the current favourite. For this we have to prove we can operate under a delegated budget and deliver our quality, innovation, productivity and prevention plan.

We have to build a brand new governance structure (while the primary care trust governance structure remains), create a whole new set of  partner relationships with local NHS providers and work closely with the council to set up an effective health and wellbeing board.

Also up there in the running is staffing our CCGs by persuading the PCT cluster to assign the people we need, as well as understanding what commissioning support is available and the work we need to do to ensure it provides the services we want.

An outsider, but always in with a chance, is developing effective systems of public and patient engagement so that, in the first instance, people know who we are and can start getting involved in what we do.

The list goes on, and of course all these things are important and are worthy contenders for the biggest challenge slot. However, the number one priority remains developing and strengthening practice and GP engagement in clinical commissioning.

But what exactly do we mean by GP engagement and why do we rank it so highly? What is important is ownership by the member practices and GPs of the new responsibilities conferred with the introduction of clinical commissioning. It is practices and GPs changing their behaviour to implement the commissioning reforms.

This might be, for example, agreeing that before a hospital referral is made, practice colleagues will review it to ensure it is appropriate. Or it might be ensuring patients follow a new pathway that has been agreed by the CCG.

The better the engagement of the member GPs in the CCG, the stronger the alignment of their actions will be to deliver their commissioning plan. Ultimately it is this that has the potential to differentiate CCGs from their predecessor primary care trusts.  

At Nene Commissioning we have learned there are seven critical success factors to effective engagement. There needs to be a locality structure with which practices and GPs find is easy to identify directly, such as their local town or area.

Practices working together in a locality need a vision for what they want to achieve. Strong clinical leadership is a fundamental prerequisite to helping create the vision and, as there is never going to be a unanimous view on what or how things should be done in a locality, it needs a tenacious and resilient leader to persuade everyone to agree on the same direction of travel.

GPs in a locality must also be able to challenge each other so that some are not left feeling that they are carrying the others. Management resource is needed to turn ideas into action. Some early wins to build confidence that change can be delivered are essential.

Finally, in a large CCG like Nene, localities can feel isolated.  Therefore visibility on how the locality is being supported by the contracting process and by the central CCG team is really important.  

Achieving GP engagement is not straightforward. It is also not fixed in either time or topic. A practice that is engaged today on a particular issue can easily become disengaged tomorrow. Any loss of engagement can quickly set a CCG back.

“Developing and strengthening practice and GP engagement in clinical commissioning” spent 52 weeks at the top of our charts in 2011. My suspicion is it will still be there throughout 2012.