Clinical commissioning groups have yet to show they are significantly better than primary care trusts in their first six months, but there are signs that the system has promise
With six months of formal existence under their belts it is now legitimate to ask whether clinical commission groups are making a difference.
‘CCGs do not seem to be having any greater success in convincing local MPs of the wisdom of controversial reconfigurations they support’
Comparisons are odious, but unavoidable in this situation. The reorganisation of commissioning consumed significant cost and effort, but more importantly distracted the service from key decisions over reconfiguration just as it had to face up to a decade of flat growth − a legacy the country will live with for years.
To make this a price worth paying, CCGs had to demonstrate they were significantly better than primary care trusts − and quickly.
That is a test they have so far failed. Indeed, there appear more questions around the relevance and efficacy of the commissioning model than at any time since its creation over two decades ago and Labour continues to promote the idea of transferring responsibility to local authorities.
But it is also a test any new set of organisations would struggle to meet in such circumstances and it should not blind us to CCGs’ successes and potential.
Before we examine those successes, let us acknowledge where CCGs have significant work to do. They have failed to control the rise in GP referrals and the jury remains out on whether CCGs can ever be unbiased judges of how much to invest into primary care. There is also the unresolved tension between how NHS England and CCGs can both play the most effective role in improving primary care.
‘CCGs appear more confident organisations than PCTs, much less afraid to challenge NHS England than PCTs were with strategic health authorities’
The influence of CCGs in some health economies dominated by large and ambitious providers is also even less significant than that of their successor PCTs − the period of reorganisation meaning plans had to be developed and implemented with very little input from commissioners.
CCGs also do not appear to be having any greater success in convincing local MPs of the wisdom of controversial reconfigurations they support. It seems a GP from a CCG is just another “NHS bureaucrat” if there are votes to lose.
A real triumph
Finally, the rate of CCG development is much more varied than the bland NHS England authorisation process would suggest.
Balanced against these problems are a number of positives. CCGs appear to have been more active in seeking dialogue and partnership with bodies outside the NHS; there is less of a sense of two managerial cultures clashing when, for example, CCGs sit down with councils, the third sector and − in some cases − private sector providers.
‘CCGs should be given a chance to help shape locally appropriate solutions along with their own future’
CCGs, in general, appear more confident organisations than PCTs, much less afraid to challenge NHS England than PCTs were with strategic health authorities and the Department of Health; and more willing to experiment with alternative provider models. They also appear to be better at balancing clinical and managerial input − a real triumph.
The system has promise
A number of CCG leaders have blazed a trail for transparency few PCT chief executives would have dared to tread. The blogging and tweeting might seem ephemeral, but does signify a group of NHS leaders prepared to be transparent about the challenges and choices ahead.
This transparency has also extended − with the best CCGs − to greater engagement with patients and their GP “members”, which will pay dividends when it comes to making decisions about those challenges.
Everyone working in the NHS should want CCGs to succeed. The system they operate in may not be perfect, but it has promise. No matter how sweet the siren voices of alternative structures, the country will not be well served by another wholesale reorganisation. Yes, there are potentially big changes on the horizon − most notably the development of vertically integrated, accountable care models − but CCGs should be given a chance to help shape locally appropriate solutions along with their own future.