Clinical commissioning groups would need to ‘radically evolve’ to be sustainable once new care models are developed, according to a report commissioned by the Nuffield Trust.

  • CCGs would need to “radically evolve” once new models of care develop and take on population health management, according to Nuffield Trust commissioned report
  • New care models could end “purchaser-provider split” in the health service, report argues
  • CCGs could survive by taking on a “strategic function” - merging to form regional bodies or folding into health and wellbeing boards
  • Regulators would become increasingly powerful as providers get more autonomous

The report, shared exclusively with HSJ, also argues that new care models outlined the NHS Five Year Forward View could bring an end to the “purchaser-provider split” that has characterised the health service since the early 1990s.

It says the responsibilities and role of CCGs would “necessarily diminish” when integrated care organisations begin to take on most population health management.

The report, by former Cabinet Office director of public service reform Ben Jupp, also argues that restricting CCG membership to GP practices would be “increasingly anomalous” and “subject to irreconcilable conflicts”. In particular, it would be difficult to reconcile conflicts of interest between GPs as members of CCGs and as providers within integrated care organisations.

“If the transformation and integration of primary care is going to be central to local strategies for improving overall care, it is difficult to envisage how these elements of commissioning can be kept separate from other decisions,” it says.

It would be “unwise to formally reorganise the structure and remit of CCGs” during the current Parliament, the report argues, particularly as there is little appetite for legislative reform following the Health Act 2012.

chief executive, Nuffield Trust Nigel Edwards

CCGs might have to find ‘a higher level role more focused on strategy and priorities’, Nigel Edwards said

However, it says in the longer term “it is difficult to see how [CCGs’] membership, scope and size can stay constant if the reforms envisaged in the NHS Five Year Forward View and Care Act are fully implemented”.

Mr Jupp argues CCGs could take on a “strategic function”, and merge to form regional bodies or fold into HWBs. It suggests the devolution of health and social care in Greater Manchester could be a “useful pioneer” for decision making at a city-regional level.

The report also suggests that if providers become more autonomous, regulators will get more powerful, as was the case with the education regulator Ofsted after the introduction of free schools.

Nuffield Trust chief executive Nigel Edwards said: “Once the new models of care are up and running, there will be big question marks over the future role of commissioners.

“CCGs, or what they evolve into, may have to find a higher level role more focused on strategy and priorities. It will make sense for providers to take on more of the job of designing and specifying care, and more of the financial and clinical risk.

“Even with all quiet on the legislative front, we are looking at the biggest shift since Margaret Thatcher in who is held responsible for healthcare in England.

“On the provider side… we may need to find new ways to make sure that powerful new models of care are held accountable to local people.”

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