Exclusive: Troubled CCGs could face 'special measures' regime

The adoption of the term, brought in last year for the most challenged NHS providers, is under consideration as part of an overhaul of the CCG assurance regime.

Its use is seen as a way to acknowledge that some CCGs also have major performance, finance or quality problems, and to create greater impetus for them to improve.

Commissioning sources estimate there are between 10 and 12 groups that could face “special measures” if the plan is adopted.

An NHS England document, seen by HSJ, also floats the possibility of creating a CCG “equivalent” to the NHS provider “administration” regimes, under which failing trusts can be broken up, merged or reconfigured.

Under the current assurance framework, CCGs are rated as “assured”, “assured with support” or “not assured”.

Only one - Barnet CCG - has been rated “not assured”, while 132 of England’s 211 groups were rated “assured with support” at the end of 2013-14.

The ratings do not identify which CCGs have serious problems.

Proposed changes to the framework, which would be formally introduced from April 2015 but probably put into practice sooner, also include a greater emphasis on data on waiting times, finance, care quality and activity.

CCGs have already experienced increased scrutiny of waiting times data and activity plans in recent months, amid concern from officials and the government about NHS performance.

The proposed changes were set out in the NHS England document, which was circulated among some commissioning leaders last month.

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Senior sources said plans remained under discussion and no final decisions had been made.

The document says the organisation wants a “much lighter touch” assurance process “for well performing CCGs”.

However, it adds: “We need to maintain a process of stepped escalation for CCGs at the other end of the spectrum.

“The new process will seek to formalise the escalation procedures and introduce a new category of special measures for where CCGs require significant support.”

It says using the term would be “consistent with the rest of the NHS” and “gives us a way of identifying those CCGs who want or need additional support”.

It also states that hospital trusts “get a maximum of one year” to come out of special measures or face special administration, and asks “do we need an equivalent?”

NHS Clinical Commissioners co-chair Steve Kell declined to comment on CCG “special measures” until the plan was confirmed. However, he said the assurance regime should be changed so CCGs spend “less time submitting plans and [are] given space to do the job”.

He added: “CCGs need assurance to be more proportionate, focusing on areas where there are problems.

“At the moment there’s a broad brush [approach].”

An NHS England spokesman said: “The framework has developed over time and consultation on the further development for [2015-16] will take place with a range of stakeholders on different aspects.”