Clinical commissioning groups will be rated four times a year on their performance and annually on their organisational capability, under a draft assurance regime to be published today.

NHS England will assess CCGs against dozens of indicators in the assurance framework. Where a group is judged to be seriously failing NHS England will use its legal powers to intervene, taking actions such as replacing the group’s leaders.

NHS England interim deputy chief executive Dame Barbara Hakin, speaking exclusively to HSJ about the draft framework, said it aimed to “give a flavour of a seriously different style of support and working together, while not getting away from the fact that commissioning groups have to deliver for their populations”.

Under the draft framework, CCGs are expected to publish their performance against the indicators quarterly. NHS England will then give them traffic light ratings against five “domains” on a “balanced scorecard”.

The domains are: care quality; NHS constitution patient rights performance, including waiting times performance; population outcomes; finance; and whether groups are addressing any conditions on their authorisation.

NHS England plans to discuss the draft framework with CCGs before publishing a final version in autumn. In the meantime, the draft proposals will be used for “checkpoints” in July and October.

Under current proposals, CCGs will be expected to publish their own performance results within six weeks from the end of each quarter.

Once a year there will be an assessment of each CCG’s organisational capability, similar to the CCG authorisation process. The framework says the annual review will also “review whether the CCG is dealing with local strategic challenges”. That is likely to include considering major service change.

NHS England will decide, based on the performance and capability assessments, whether it needs to use its formal powers of intervention. If not, it will discuss with each CCG what support it could offer to help them further improve.

The framework says the “expectation is the majority of CCGs will receive support from NHS England on an informal basis…[but] we need to identify the mechanisms by which NHS England would use its statutory powers to intervene where there were serious concerns”.

Dame Barbara said quarterly performance reviews were about checking groups were “delivering on [their] promises”.

“For the vast majority of CCGs this will be about how we support you,” she said.

Dame Barbara said assurance would be lighter for “leading edge” CCGs. For example, the best CCGs would only receive site visits as part of their capability reviews once every three years.