Clinical commissioning group leaders entering their first contract negotiations want to tighten the screw on providers, at the same time as promoting service integration, HSJ’s CCG Barometer survey reveals.

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Most emerging CCGs are now involved in negotiations for the first time as they prepare to take on their full powers in April.

HSJ asked their leaders about what impact they believed their CCG’s contracting would have compared to the past performance of primary care trusts.

There were 85 responses to the survey - 48 per cent were chairs and 44 per cent accountable officers. The remaining eight per cent were other executive or clinical board members.

The impact that CCGs believed was most likely was that providers would be more “pressured to provide integrated services”. Ninety-nine per cent of those who responded said this was either likely or much more likely to be the case than in the past.

Many existing large NHS providers may welcome the emphasis on integration rather than competition. The introduction of more competition was one of the least popular options, though 47 per cent still thought it was likely.

CCG leaders also widely believe there will be more funding “moved to community services”, more “requirement to reconfigure services”, “bigger penalties for quality problems” and that providers’ income and activity will be reduced, or their growth slowed.

The only impact which a majority of CCG leaders said was less likely was “less attention being paid to finance and activity”. Sixty-two per cent said this was less likely, suggesting that while CCGs want to prioritise quality and service change, they are still keen to keep a tight grip on finance.

Johnny Marshall, an adviser to the NHS Commissioning Board and senior member of NHS Clinical Commissioners, said it was important CCGs talked with providers about what they wanted to achieve. “If you have developed a good understanding and it’s reflected in contracts, you are likely to be more successful,” he said.
There were 85 responses to the survey - 48 per cent were chairs and 44 per cent accountable officers. The remaining 8 per cent were other executive or clinical board members.

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Leaders divided over grip

The survey found clinical commissioning group leaders were divided over whether the NHS Commissioning Board’s planning guidance gives the national board too much “grip” over them.

The Everyone Counts guidance, published before Christmas, set rules for how CCGs will operate, plan and be performance managed.

Fifty per cent said the guidance “will give the commissioning board too much ‘grip’ [and] is not consistent with the CCG model”. Forty per cent said it “has the right balance [and] is consistent with the CCG model”.

No respondents said the guidance will give CCGs too much “flexibility” and 10 per cent said they did not know.

A much larger proportion of GPs said it would give the commissioning board too much “grip” than was the case with non-GPs. For GPs the proportion was 61 per cent; for non-GPs it was 31 percent.

Problems with the guidance identified to HSJ by CCG leaders include the requirement for them to hold back 2 per cent of their budget from routine spending. They will have to get permission from their commissioning board area team officials before spending it.

The guidance also identifies about 35 “progress” measures for CCGs. One CCG leader said this may change their plans and priorities.