Clinical leaders are ‘more willing to challenge or ignore diktats and messages from above’ than their managerial colleagues in clinical commissioning groups, research shared exclusively with HSJ has found.

  • CCGs perceived by clinicians as “less beholden to any higher authority” than PCTs
  • Divide among groups over whether primary or secondary care should be priority
  • Researchers spoke to 500 CCG governing body members for first year of three year study

CCGs are also “perceived by the players within [them] as less beholden to any higher authority than their [primary care trust] predecessors”, according to the first year findings of a three year study into the role of clinicians in CCGs. 

The study found a divide between CCGs that believe their main role is to commission secondary care, and those that believe their priority should be addressing primary care.

Researchers asked questions to 500 CCG governing body members and closely examined 15 CCGs as “reference groups” to “assess emerging trends and developments” for the study conducted by the Open University and University College London for the Health Services and Delivery Research Programme. The programme is funded by the National Institute for Health Research.

The study found that clinical leaders “seemed to be more willing to challenge or ignore diktats and messages from above, and to encourage their managerial colleagues to do the same”.

They are also seen as “able and more willing to challenge unacceptable performance by their colleagues” and to be more effective at achieving service redesign.

One CGG chair said: “We managed to get a GP led emergency care centre in [accident and emergency] in three months when the PCT had tried to achieve this for five years and failed.”

Study co-author Martin Marshall, professor of healthcare improvement at University College London, told HSJ that clinical leaders are “demonstrating that they are speaking and acting differently from non-clinical leaders”.

“What we don’t know yet is what the implications of that are,” he said.

Based on the findings, Professor Marshall said clinical leaders were “focused on outcomes and less interested in processes”.

“They don’t really mind how they do things as long as they feel they’re having an impact and… they’re less beholden to the system,” he added.

Having the option of eventually returning to full time clinical practice meant that some clinicians felt “degree of freedom in what they say and do”.

Professor Marshall added he was “particularly interested” that, in some organisations, “clinicians have been encouraging their managerial colleagues… to adopt a similar stance”.

However, the study found some concern from managers that GPs “had a tendency to ‘jump in and fix’ and to get involved in detail from a provider perspective rather than fully grasp the commissioning brief”.

“Instead of working to a commissioning cycle starting with population needs, they allegedly tended to leap in with solutions,” the report said.

One of the clearest divides the study identified was between the groups that “placed emphasis on addressing needs in primary care” and those that “assumed their role was to be mainly restricted to commissioning secondary care”.

This was partly explained by a “legacy effect”, it said. CCGs in areas that traditionally took a hands on approach to dealing with primary care concerns continued to do so by helping develop GP federations.

One CCG chief officer said: “As a CCG, even though we were not directly responsible for the GP contract and pay and rations, we felt it important to work at developing a sound primary care service and to help GP practices find new ways of working.”

There was near even split between CCGs about the role of NHS England in their activities. Fifty-three per cent of survey respondents said the national organisation had “little or some influence locally”, while 47 per cent thought it was “quite a lot” or “very extensive” influence.

Some chief officers were “cautious” about the extent of CCGs’ autonomy. According to the study, “there was a degree of compliance with the requirements and expectations of NHS England”, with some regions “perceived as seeking to continue in a command and control style”. However, “CCGs in general saw themselves as being better able to resist these attempts” than PCTs had been.

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