Around a third of clinical commissioning groups are bidding to take over responsibility for performance management and budgets of their member GP practices from April, HSJ can reveal.

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 Primary Care CCG heat map

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.

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”.

HSJ Primary Care CCG table

*The number of CCGs applying for full delegated co-commissioning identified in the regional table does not equate exactly to the 77 nationally. This is because some of those which have applied have not yet identified their decision to HSJ.

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”.

An NHS England spokesman said: “The introduction of co-commissioning is an essential step towards expanding and strengthening primary care to help to drive up quality, reduce health inequalities and put the NHS on a sustainable path for the future. 

“We are delighted with the positive rate of response, with 77 CCGs having applied to take on delegated responsibilities for primary medical services”.

This story was updated with NHS England’s response on 23 January and graphics updated on 26 January.

Levels of co-commissioning

  • Delegated commissioning CCGs take full responsibility for commissioning GP services, including budgets, contractual performance management and complaints about member practices.
  • Joint commissioning A CCG or group of CCGs form a committee with their NHS England area team to jointly make decisions about GP services
  • Greater involvement CCGs work more closely with their NHS England area team, but without having any decision making functions. This option would require no constitutional change or formal approval from NHS England.



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