Reduced role of CCGs risks losing ‘grit in the system’

Julie Wood, who is stepping down as the organisation’s chief executive in June, said: “We need to ensure as we move into collaboration and integration being the norm that we don’t lose the grit in the system.”

Without it, she said the NHS was at risk of returning to “what some might say at times was an airless room”, before the internal market was introduced.

NHS England has proposed that procurement and competition rules be substantially weakened; and has indicated that clinical commissioning groups — as well as merging to cover much larger populations — will become more “strategic”, by handing over many responsibilities to providers.

Ms Wood said: “If for whatever reason a provider, or group of providers, isn’t able to or willing to do what the evidence suggests is the right thing to do, you have to have the ability to do something about it. Otherwise you’re failing within your responsibilities as a purchaser or a commissioner.”

She said although competitive procurement was not “what gets [commissioners] out of bed… you still need to have that as a lever”.

Ms Wood has been chief executive of NHSCC since it was set up in 2012; she previously was the national director of practice-based commissioning for the NHS Alliance, and before that held senior positions in local commissioning organisations.

She said the system will need the new “best value test”, as set out in NHSE legislative proposals, to be robust so that commissioners can be “held to account” for their contracts.

NHS England has recommended current procurement rules should be replaced by a form of best value test, but has not detailed it, and Ms Wood warned: “What it would look like and how you are actually able to deploy it and use that to deliver the change you want is quite tricky.”

Local government uses a best value test but, Ms Wood said: “It is not easy to see how that immediately translates into the health sector.”

She also warned that as the speed of ICS change increases, NHSE must not be “inadvertently tripped into a top-down reorganisation, as you’ll lose at least three years’ worth of transformation” in doing so.

She added that “diverse clinical leadership is really, really important” for ICS to work, and the NHS “mustn’t revert back to [a] sole managerial model of leadership”.

The shrinking CCG landscape

HSJ has reported on plans to dramatically reduce the number of CCGs in England. Ms Wood expected the final number of CCGs to fall between 60 and 80, with mergers likely to continue beyond April 2021.

She said NHS England’s aim to have one CCG per ICS “will not work for all systems”, and predicted a few large STPs/ICS would split, increasing the count from the current 42 to around 47.