New local commissioning groups – where established – will be subject to a list of new requirements and conditions, under revised government reform plans.

The government announced changes to its proposals today.

They include the NHS Commissioning Board will retain budgets where consortia – which will now be called clinical commissioning groups – are deemed not to be ready.

In that case the CCG will be “legally established but operating only in shadow form, with the [NHS board] commissioning on its behalf”, the statement on the changes says. It says: “Some will only be authorised in part. Others will only be established in shadow form.”

CCGs will not be optional, however, and all GP practices must be members. The government statement says the commissioning board will “work with the GP practices and other stakeholders in these areas to develop fully operational commissioning groups and hand over commissioning responsibility to them as they are ready, so that we move, over time, to avoid a two-tier system of commissioning” [ie with clinical groups only in some areas].

It means the NHS Commissioning Board will retain extensive local structures in many areas. The government statement says: “The primary care trust ‘cluster’ arrangements will be reflected in the local arrangements of the NHS Commissioning Board.”

The statement says the board will “be subject to the same duties of transparency and engagement”. It is unclear how these requirements will be met in a body expected to have a single board and operating structure.

CCGs will be subject to a string of new requirements both in order to get authorised and once they are operational.

This includes:

  • Having a governing body which includes: A practising nurse, specialist consultant doctor and “at least two lay members”. One of the lay members must be either the chair or deputy chair. They will meet in public and publish minutes, and publish “details of contracts with health providers”.
  • Health and Wellbeing Boards can “choose to object” to a local CCG being established.
  • Requirements which appear to make it very difficult to form CCGs made up on non-neighbouring practices, or which do not share boundaries with local authorities. The statements say CCGs “must commission all urgent and emergency care within their boundaries, and are also responsible for any unregistered patients who live in their area” and: “Their boundaries should not normally cross those of local authorities, with any departure needing to be clearly justified.”
  • Have to “follow” the advice of local clinical networks including “clinical senates” hosted by the commissioning board. Health and Wellbeing Boards can refer consortia plans to the Commissioning Board.
  • “Duty for clinical commissioning groups to promote integrated services for patients, both within the NHS and between health, social care and other local services”.