Clinical commissioning groups failing for more than a year could have their responsibilities removed and handed to other organisations, new guidance indicates.

  • Guidance says CCGs could have some of their responsibilities passed to other organisations if they are failing following special measures
  • Follows comments by Simon Stevens saying councils or providers could have greater role
  • Directions issued against three struggling CCGs
  • CCG scorecard to be introduced for 2016-17

NHS England chief executive Simon Stevens told HSJ in June that struggling groups could have their powers given to other CCGs, local authorities or providers; but there has so far been no mechanism for this.

Guidance on CCG assurance and CCG special measures distributed by the national organisation this week appears to partly formalise such an approach.

NHS England has also this week used its intervention powers against three more CCGs.

The document explaining how special measures can be used for CCGs in future says the regime will be “applied to a CCG facing persistent performance, financial or governance problems where it cannot demonstrate the leadership capability and capacity to deliver improvement on its own”.

NHS England will closely oversee and work with the CCG for a year after imposing special measures. They can then be removed if the CCG has sufficiently improved or the measures extended for a short time.

Simon Stevens

NHS England is going to be ‘more vigorous’ with struggling CCGs, Simon Stevens said

However, where CCGs have “not made expected progress” after the year, the national organisation can “trigger changes in the management, governance or structure of the CCG’s responsibilities, with the potential for other CCGs or relevant bodies to take over aspects of the local commissioner’s responsibilities”.

Mr Stevens said in June NHS England would be “more vigorous” with CCGs with serious problems and that, in addition to replacing senior leaders, it could pass their responsibilities to other CCGs, local authorities or “an integrated provider”.

Although the law allows NHS England to take control of CCGs itself or pass their responsibilities to other CCGs, it is not clear whether it has the legal powers to transfer them to councils or providers. NHS England has not yet placed any groups in special measures.

However, during 2015-16 it has used its powers of legal direction – which are also employed for those with severe problems – against four CCGs. Directions were issued this week for Northern, Eastern and Western Devon CCG, Surrey Downs CCG and Enfield CCG, and in May for Bedfordshire CCG. Directions put on Barnet CCG last year have been lifted in recent weeks.

The 2015-16 assurance framework will see CCGs rated for the first time as “outstanding”, “good”, “limited assurance” or “not assured”, but results will not be issued until after the financial year.

A CCG assurance operating manual, also sent to groups this week, indicates a new “scorecard”, rating them using quality indicators and judgements on capability, will not be introduced until 2016-17.

The health secretary has asked for the new rating system to be developed and results published on the MyHealth website. The approach was questioned before the general election by some commissioning leaders. Jeremy Hunt has since asked King’s Fund chief executive Chris Ham to work on it with NHS England. The operating manual says: “A CCG scorecard will be developed during 2015-16 for publication as part of MyNHS. This will provide a clear, common information source for assurance from 2016-17.”

'Other bodies' could take powers from failing CCGs