Local clinical commissioning will see substantial evolution linked to new care models and moves to plan services across a larger footprint, but will remain important, NHS Clinical Commissioners will argue in a new report.
The organisation, which represents the large majority of clinical commissioning groups and their leaders, is due to publish The Future of Clinical Commissioning tomorrow.
It addresses the major changes to commissioning taking place, and which are expected to accelerate, with the development of “accountable” provider structures taking on more responsibilities; and the shift of mainstream service planning on to patches bigger than most CCG areas, under the sustainability and transformation process.
The report, based on interviews with CCG leaders and other key stakeholders, argues:
- Some CCGs, with the development of accountable providers, will become “strategic commissioners – taking a multi-annual place based and outcomes oriented perspective with emphasis on quality, oversight and evaluation”.
- There “is unlikely to be one model of how local commissioning functions are arranged”.
- There should not be a statutory reorganisation of commissioning.
- Strong clinical involvement in commissioning should continue, notwithstanding the potential for conflict of interest with roles in emerging new providers.
- In some cases commissioning will happen across a bigger areas. Some CCGs will merge and others will collaborate “much more closely”, this should always “be driven by what works best locally”.
- Calls on NHS England and regulators to “adopt a similar place-based approach [to the system locally], by designing and enacting proportionate regulatory regimes”.
The document says: “We strongly believe that clinical commissioning is here to stay, but we will and are already seeing a CCG evolution.
“As this takes shape, we must not lose the valuable contribution local clinical leaders make to the process by working constructively alongside CCG managers because it is clear that there is an ongoing need in the NHS for a strong health and care commissioning function for the future.”
It continues: “Within current structures we do need to rebalance the financial and human resource that currently sits within the commissioning system to support more strategic commissioning by CCGs.”
With “new models of care become more widely established, we foresee some recalibration of the commissioning tasks”, it says. “This is where some of the day to day transactional elements of commissioning may transfer to what are becoming collectively described as accountable care systems, taking direct responsibility for day to day care for a defined population within an area.
“We fully anticipate that in the future there is unlikely to be one model of how local commissioning functions are arranged – but whatever the model, our members are clear that it should be locally defined and driven.”
A number of CCGs are working on models with could see substantial responsibilities which currently sit with CCGs move to providers, such as the proposed “accountable care organisation” in Northumbria and planned multispecialty community provider in Dudley. CCGs in a number of areas have also proposed merger and/or shared leadership in recent months.
NHS Clinical Commissioners co-chair Graham Jackson, a GP and chair of Aylesbury Vale CCG, says in the document: “Bringing in people like me – jobbing GPs, who aren’t enmeshed in NHS management – has been crucial to commissioning. We must preserve that local clinical voice and influence.”
Co-chair and Blackpool CCG chief clinical officer Amanda Doyle said: “The unique value of CCGs is their combination of credible clinical leadership, expertise and knowledge of the communities they serve. This local dimension must not be lost. Collaboration is also key – only through developing effective place based relationships can we hope to assure the long term sustainability of the NHS.”