One year on from their statutory formation, the CCG barometer shows that clinical commissioning groups remain full of ambition.
However, there is a remaining concern that CCGs don’t have enough capacity or access to skills to deliver the care economy transformation that is needed. More worryingly, where they do have a vision and ability, the Barometer suggests they feel frustrated by the system. Transforming innovative ideas and goodwill into operational realities that deliver the outcomes patients and populations need will be critical for CCGs in their second year in order to meet the longer term challenges outlined in PwC’s report NHS@75, published last year.
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The CCG Barometer highlights clinical commissioners’ frustrations at their inability to play a leadership role in the health system as a whole and to make some of the big transformational changes required. While GP engagement, public involvements and joint working with local authorities are all deemed to have got better, this hasn’t translated into an improved ability to support and enable sustainable providers or to control costs. Despite this, ambitions for the next year remain high, with primary care reform and integrated care high on the agenda.
When it comes to primary care reform, almost half of respondents see the inability of CCGs to directly contract GP services as a significant barrier to transformation. With GP services facing rising demand, addressing the challenges facing primary care cannot be ignored. International examples, such as the Midlands Health Network in New Zealand, show us how much can be achieved by a GP led reform of primary care. Clearly there is an important role for CCGs to play in this area and CCGs need to take a bold approach, pushing on perceived boundaries of the possible. The resources needed to develop a new approach to primary care must not be underestimated and cannot be left to the CCGs alone.
Abilities face a challenge
Delivering coordinated care, designed around the needs of patients, requires strong working relationships across the care economy. As CCGs move towards new models of whole person care and outcome based commissioning – over 60 per cent of those surveyed said they intended to introduce outcome based contracts over the next 12 months – their ability to deliver truly integrated care will come under challenge.
At the local level, CCGs are positive about their engagement with local authorities, GP member practices, providers and their local areas teams. Beyond this however, they are less positive about their interactions with regulators, the regional teams and NHS England. A fifth of CCGs said they had no relationship with their regional teams. This lack of alignment and engagement will be a real challenge in year two as CCGs forge ahead with innovative new models of care against a background of incentives and budgets that don’t stack up for their patients.
As we look ahead, over half of respondents listed access to data and technology and the top-down focus on finance and targets as significant barriers to change. Unsurprisingly as we enter the run up to the general election, political opposition to service changes was also highlighted. However, with little let up in the growing pressures the NHS is under, now is not the time for CCGs, or their partners, to slip into pre-election paralysis. As they enter their second year of operation, CCGs must hold their focus and with it their nerve to transform their ambitions into tangible outcomes for patients.
Kalee Talvitie-Brown is a partner and Rob Yearsley is a director in PwC’s health practice
CCG leaders: Reforms have not improved control of cost and activity
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Comment: CCGs must hold their nerve