Joint commissioning and involving clinicians are the major challenges for newly-authorised clinical commissioning groups, HSJ research has revealed.

More than three-quarters of clinical commissioning groups have now been approved as part of wave three of the authorisation process, and an HSJ analysis of conditions put on their approval reveals the two new areas of concern.

The results of the penultimate wave of the NHS Commissioning Board’s CCG authorisation process were published last week.

Seventy-seven per cent of CCGs have now been authorised, and the remainder are expected to be approved next month.

The board issued five wave-three CCGs with legal directions. The directions say the groups must work with the board on their financial plans and improving their capacity.

The board will provide them with “more intensive support” than other groups, it said.

The CCGs with directions are Eastbourne, Hailsham and Seaford CCG, Newham CCG, Herefordshire CCG, Scarborough and Ryedale CCG and Vale of York CCG.

As in waves one and two, the most common areas for which CCGs were given conditions on their authorisations concerned either financial and service change planning- or having effective systems to oversee safety and clinical risk.

However, in wave three there were more conditions related to involving clinicians and joint commissioning than in previous waves.

Across all the CCGs authorised in wave three there were 30 conditions related to “widespread involvement of other clinical colleagues providing health services locally” and 20 related to “strong arrangements for joint commissioning and co-operation with local authorities to enable integration, deliver shared outcomes and fulfil statutory responsibilities, drawing on public health advice”.

Announcing the results of the third wave, commissioning board national director for commissioning Dame Barbara Hakin said: “The majority of CCGs are now authorised and up-and-running and we are moving at pace towards a clinically-led NHS that is focused on delivering improved health outcomes, quality, patient safety, innovation and public participation.”


Authorisation so far: Waves one to three


 Total CCGsProportion of CCGs authorisedNumber of conditions
Midlands and East6174%191



Authorisation domainNumber of conditions
Clear and credible finance and service plans224
Constitutional and governance arrangements132
Collaborative arrangements and commissioning support65
Strong clinical and multi-professional focus64
Engagement with patients, carers and communities52
Great leaders50