Exclusive: CCGs should be 'brought together', says King’s Fund

NHS commissioning must be carried out on footprints bigger than current clinical commissioning groups, the King’s Fund has recommended.

In a report published today, shared exclusively with HSJ, the think tank says: “Scarce commissioning expertise needs to be brought together in footprints much bigger than those typically covered by [CCGs], while retaining the local knowledge and clinical understanding of general practitioners.”

It stops short of specifically saying whether CCGs should merge or not in order to achieve this joint working.

The report says the move is necessary to enable providers to “establish place based ‘systems of care’ in which they work together to improve health and care for the populations they serve”. This approach will give “the best opportunity for NHS organisations to tackle the growing challenges that they are faced with”, says the report by King’s Fund chief executive Chris Ham and integrated care programme manager Hugh Alderwick.

NHS England and NHS Improvement are expected to ask NHS providers and commissioners to work jointly as “health systems” to produce multi-year “financial sustainability and service transformation plans” by next summer. NHS England chief executive Simon Stevens was expected to elaborate on this proposal at an event today.

The national bodies are likely to require the plans to cover multiple CCG areas in many cases. In the past two years CCGs have been asked to submit joint plans across “units of planning”. However, Mr Stevens has indicated he generally will not approve CCG mergers, as he believes organisational change would distract from more important work.

The report adds: “Strategic commissioning will require thoughtful evolution towards a system in which the clinical expertise and local knowledge of CCGs are retained and where NHS commissioning is based on footprints much bigger than those typically covered by CCGs today.” It cites areas such as north west London, Greater Manchester and Staffordshire, where independent CCGs are working together.

Professor Ham told HSJ: “Commissioning in England must become more strategic and integrated for place based systems of care to become a reality. This means commissioners focusing on defining and measuring outcomes, putting in place budgets covering the whole of a population’s care for providers to collectively manage, and using long term contracts linked to the delivery of these outcomes.

“It will also mean commissioners working together in footprints much bigger than those usually covered by CCGs today – not least to enable commissioners to negotiate on equal terms with providers. The challenge will be in retaining the local knowledge and clinical expertise of CCGs, while also working to transform services with providers across wider geographical areas.”