Clinical commissioning group leaders’ confidence in delivering on their responsibilities has increased, but they are grappling with significant confusion in the reformed NHS system.

These are some of the findings of the third HSJ clinical commissioning barometer survey, published with GatenbySanderson.

It is the first of the quarterly surveys carried out since CCGs took on their full powers as part of the Health Act commissioning reorganisation.

Ninety-four CCG leaders from 86 different CCGs, 41 per cent of the total 211, answered the survey. Ninety per cent were chairs or accountable officers and the other 10 per cent were other governing body members.

Asked to rate their confidence that their CCG “can stick to its budget without compromising care quality or access in the next year”, the average score was 7.2. That compares to an average of 6.5 in response to the same question in January, and 6.6 in October.

CCG respondents said the increased confidence probably reflected the fact they now have fixed senior leaders, have filled most posts and taken on their full powers.

However, there are also signs CCGs leaders are frustrated and irritated about a range of problems with the new system.

That appears to be reflected in deterioration in CCGs’ relationship with their NHS England local area team − a critical link in the new commissioning arrangements.

Asked which phrase best described their area team’s interactions with their CCG, 68 per cent of leaders said it was “good” or “very good”. This is a drop of five percentage points when the same question was asked in January.

Numerous CCG leaders raised concerns about the operation of the new system in response to the survey.

One said: “[There are] lots of grey areas in terms of changing organisational responsibilities.”

Another claimed: “Despite close involvement of [the] local area team with local issues, there is no clarity on who can make decisions and I have experienced different lines depending on who I have spoken to.”

Another cited “attempts at ‘command and control’ by [NHS England] local area team in service configuration areas that they do not commission”.

CCG barometer survey results

CCG barometer survey results

The survey also revealed differences among CCG leaders about responsibility for major service change.

Fifty-one per cent agreed with the statement: “CCGs are leaders of the work jointly and equally with each other. NHS England will contribute along with other partners.”

However, 30 per cent said NHS England and CCGs were “joint leaders of the work” and seven per cent that “NHS England is the convener of the work, with CCGs as partners”.

Bassetlaw CCG chair Steve Kell, co-chair of the NHS Clinical Commissioners leadership group, said: “CCGs are confident [they are] strong organisations and have the right structures.

“The difficulty is the immaturity of all commissioning organisations now. [There is] still uncertainty about commissioning responsibility and relationships.

“There is also an issue about consistency nationally in relation to some of the issues − different areas are dealing with things in a different way, and relationships with CCGs vary.”

NHS England interim director of commissioning development Rosamond Roughton, responding to the survey results, told HSJ: “We realise getting relationships right is absolutely key.

“How the system operates will continue to develop. We need to make sure we get the balance right, for example in the need to provide assurance to the public, and with local area teams’ role as convener.”

She said NHS England’s evaluation of its performance would include an independently-run survey of CCGs’ relationships, to be carried out later in the year.