Updated: Third of CCGs apply for full co-commissioning powers over GP members

Seventy seven CCGs (37 per cent of the total) have submitted “co-commissioning” proposals to NHS England to take on full delegated primary care responsibility from April, which also includes managing complaints about practices and GPs.

Primary care is currently commissioned by NHS England’s area teams, but its chief executive Simon Stevens announced last spring he wanted to hand the responsibility to CCGs. They were asked late last year to choose between three “levels” of co-commissioning (see box, below)

They had to tell NHS England by 9 January if they wanted full “delegated” responsibility, and by 30 January if they had chosen other options.

A comprehensive survey of all CCGs by HSJ has identified the choices made by 198 groups, the remainder saying they had not decided or would not say. Forty-three per cent (90 groups) have applied for “joint commissioning” and 12 per cent (26 groups) have applied for the lowest option of “greater involvement”. Five CCGs have said they do not want any co-commissioning role.

HSJ also found regional differences in enthusiasm for delegated commissioning (see map graphic). We also identified a tendency for CCGs to choose the same level of co-commissioning as others within their area team. For example, all CCGs in Derbyshire and Nottinghamshire area team submitted bids for delegated commissioning. Every CCG in Thames Valley and Cheshire, Warrington and Wirral area teams, and 10 out of the 12 CCGs in Greater Manchester, opted for joint commissioning.

The CCGs that have applied for full delegated powers had, on average, more deprived populations, HSJ found. NHS Alliance chair Michael Dixon, who is also a senior figure in CCG representative body NHS Clinical Commissioners, said these areas may have greater impetus for change because general practice tends to be poorer.

There appeared to be no link between CCGs’ size and their decision.

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Paul Maubach, chief officer of Dudley CCG which has bid for full delegated commissioning, said it would allow for greater integration between different parts of the health system.

“It makes no sense to be commissioning all the services that wrap around [general] practice, and not commission the practice itself,” he told HSJ.

However, leaders of CCGs that opted only for greater involvement with NHS England’s commissioning expressed concern about the lack of clarity around governance arrangements for delegated commissioning, and said there was insufficient time to put arrangement in place for April.

Northern, Eastern and Western Devon CCG chief officer Rebecca Harriott said the organisation was wary of “the due diligence process that would need to go on [for a funding] transfer of that scale”, which was “something more than we wanted to concentrate on at the moment”.

Cumbria CCG chair Hugh Reeve said: “The timescales were so tight and the guidance seemed really quite vague… [so] we felt we couldn’t discuss [it] appropriately with our membership.”

He said his group felt it would be a “a step too far” while his group was dealing with “large financial problems across the whole system” and two trusts in special measures.

Dr Dixon said full delegated commissioning was “absolutely the direction of travel” and predicted all CCGs would be adopting it within three years.

“It’s just a question of how fast [CCGs] are going towards delegated budgets and how ready they are to do so,” he said.

However, British Medical Association GP committee chair Chaand Nagpaul said CCGs’ move to full commissioning of GP services was “in some cases [a] reflection of the external pressures”, including NHS England area teams merging and reducing staffing, resulting in “inadequate levels of service provision”.