STRUCTURE: A troubled clinical commissioning group in the North West has structures which are “not fit for purpose” and a dysfunctional relationship between two of its leaders, an NHS England review has found.

The national commissioning organisation began an investigation into Wirral CCG after serious concerns were raised in May about its leadership.

It is the first time such action has been taken in relation to a CCG.

The CCG’s chair, Phil Jennings, and its chief clinical officer, Abhi Mantgani, “stepped away” from their duties to make way for the review.

NHS England today published the findings of its “capability and governance review”, which found the problems the CCG had experienced were “manifesting” from an unusual CCG governance structure, but exacerbated by the relationship between the two individuals.

Wirral CCG is composed of three consortia, which are themselves made up of “mosaics of like-minded practices rather than discrete population based commissioning areas”.

The three groups, formed from practices which had worked closely together in the past, had during 2011 and 2012 proposed to form separate CCGs, but merged after being told they would not be authorised.

Its governing body is based on proportionate representation from these consortia, and there is no membership forum which operates across the whole CCG.

A briefing on the review findings published by NHS England said the “increasingly challenging financial environment” exposed these “complex governance arrangements” as “problematic”.

“The review found that the CCG has been working within, and increasingly not coping with, a set of organisation arrangements which are not fit for purpose,” it said.

The NHS England report said the structure was not conducive to “ownership of whole system strategic approaches” and made it “difficult” for the CCG to set overall direction.

The CCG’s governing body was aware of these difficulties but had not “overseen the necessary processes of development to address those concerns”. Instead problems were exacerbated by the relationship between the chair and CCO.

“Taken together, the CCG chair and CCO do not demonstrate the necessary close working agreement about what needs to change in the CCG, by when, to develop the CCG, nor how the necessary leadership for this work would be provided between the two roles,” NHS England’s briefing said.

Its recommendations included reviewing the consortia structure, revising governance arrangements and developing governing body capability.

NHS England also reported evidence of a “poor state of relationships” with Wirral University Teaching Hospital Foundation Trust, and in particular a “relatively challenging personal relationship” between the trust’s chief executive and the CCG CCO.

Wirral CCG said it accepted all of NHS England’s recommendations and would develop a more detailed action plan to implement them.

The national body’s regional director of operations and delivery in the North, Jon Develing, will continue to act as the CCG’s interim accountable officer, and NHS England will continue to provide it with support.

NHS England had not commented on the future of Dr Jennings and Mantgani’s positions at the time of publication.

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