CCGs confident in joint planning process despite major barriers

However, the 54 chairs and accountable officers who responded to the survey also said there were many barriers to doing so.

Responses to the commissioning barometer, carried out in association with Capsticks, cover around one in four of the 209 CCGs, and were submitted in January and early February.

Asked to rate their confidence in whether they can produce and agree a strong STP, 58 per cent said it was high, and 4 per cent said it was very high. Thirty-five per cent had low confidence and 2 per cent very low.

When asked to rate and suggest potential barriers to agreeing STPs, those of most concern to CCG leaders were national factors – such as insufficient social care or NHS funding; the need to meet NHS organisations’ own targets and priorities; and national financial and regulatory incentives (explore the data).

However several local factors also had majorities saying they were a small or major barrier. Those of widest concern were: disagreement about future hospital activity; self-interest of clinicians in secondary and tertiary care; confusion or clashes over planning footprints; the personal approach of senior leaders; and a lack of organisational/staff capacity (explore the data).

Under national planning rules, all NHS organisations have been told to form planning areas, referred to as footprints, then develop an STP for that health system covering the years until 2020-21 to submit by the end of June. They will be used to decide access to transformation funding in future years.

One respondent said “lack of realism by NHS England that this sort of large-scale change takes a great deal of energy commitment and time” was a major barrier. They said the process was “another back door reorganisation that will further distract us” and would “require the relinquishing of autonomy before the implications are clear”.

Another said: “STP needs to be underpinned by system financial control totals. The regulators are moving in the right direction but the shift from organisation to system needs to happen more quickly.”

A third said they were being stopped from being “able to determine the footprint we believe is right for our population”.

Another CCG leader said: “The greatest challenges I am facing relate to the ambivalence of politicians with regard to their leadership role in relation to health and care. There is not even theoretical buy-in to that responsibility from many, and without political will, political courage and political leadership, place based planning will simply provide politicians with more opportunities to bash the NHS.”

NHS Clinical Commissioners co-chair Amanda Doyle, also Blackpool CCG chief clinical officer, told HSJ the June STP submission deadline was “actually quite soon… We are talking about footprints with several commissioning organisations as well as several providers and to co-ordinate a plan on that basis if you’d not started already will be quite difficult to do by the end of June.”

In relation to lack of capacity, Dr Doyle said: “All areas are used to planning each year on a local basis… but things are tight [and] there is a real problem with the lack of capacity within CCGs. Although we’ve seen protection of the running cost allowance this year we are still finding that CCGs are struggling.”

An NHS England spokesman said it was “no great surprise that [CCG leaders’] responses reflect the complexity of the challenge facing their CCGs, for whom the next 12 months will certainly be a major challenge”.