Sixty-three clinical commissioning groups have taken on fully delegated responsibility of their primary care budgets despite serious concerns raised by some groups, HSJ has learned.
One CCG that had been approved by NHS England to take on delegated commissioning of primary care dropped out before the new powers were due to take effect last week, but NHS England has not revealed the name of the group.
HSJ also understands that City and Hackney CCG had been conditionally approved to take on delegated commissioning in 2015-16, but it will now not be taking on the new responsibilities this year.
Commissioners were given only two weeks to sign delegation agreements with NHS England and finalise potentially complex legal arrangements for taking control of their primary care budgets, HSJ revealed last month. Several CCG leaders said they were concerned about the lack of time they have to prepare to take on their additional responsibilities.
NHS England issued a letter, seen by HSJ, to all CCG accountable officers late last month to “clarify and offer assurance” following concerns raised by some groups about the terms of the delegation agreement.
The letter said the organisation “received a number of queries and concerns from CCGs about the delegation agreement”. It was signed by NHS England director of commissioning strategy Ian Dodge and Blackpool CCG chief clinical officer Amanda Doyle, who is also co-chair of NHS England’s primary care co-commissioning programme oversight group.
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“Some of these queries have been points of clarification, whilst others have been concerns about the implications of certain clauses,” it added.
CCGs’ worries related to when and how they would be allowed to use the termination clause, amendments to the delegation agreement, changes to delegated funds, liabilities for losses, legal claims and monitoring.
The letter also revealed that NHS England was still finalising a service level agreement with CCGs around staffing.
NHS England would be “updating the delegation agreement to address the main concerns CCGs have”, it said.
CCGs would also not be required to “undertake anything for which NHS England is not already responsible”.
Dr Doyle, who is also co-chair of NHS Clinical Commissioners, told HSJ: “We are delighted that 63 CCGs have now started commissioning primary care with full delegated budgets.
“We are really pleased that we were able to work through all the issues CCGs raised [and are] working with NHS England to get those sorted out. [It’s] been a lot of work.”