The big switch: what the change to CCGs could mean

Elliot Bidgood, 26 March 2013

On April 1st, 211 Clinical Commissioning Groups (CCGs) will officially succeed the 152 current Primary Care Trusts (PCTs) as the main commissioners (purchasers) of healthcare in the NHS. According to the NHS Commissioning Board (NHS CB), the arms-length independent body that will now exercise day-to-day operational control in the service, all CCGs are now cleared to take over. CCGs, made up of England’s 8,000 GP practices, will collectively handle a health budget of £65bn. Another £35bn will be spent by the NHS CB on centralised commissioning and public health activities and on general strategic planning.

A number of issues have been raised about the change, which we should watch for:

• It has been suggested that while GP-led organisations might well be better than the old PCTs at understanding the detailed health needs of patients, it may take time for them to develop the ‘big picture’ strategic planning instincts that PCTs had for dealing with the needs of local populations writ-large
• There may still be tension between the NHS CB, which some have characterised as a “remote, central quango”, and the CCGs, which are intended to drive localism, diversity and patient accountability
• Concerns have been raised about GP enthusiasm for commissioning, with comparisons being drawn with the GP fundholding in the 1990s. However, fundholding did sometimes reduce waiting times for patients and the NHS CB believes that engagement between CCGs and their constituent GP practices is sufficient in most areas now
• A study by the Nuffield Trust stressed the importance of consultation, timely decision-making and clear expectations about intended outcomes. Also important will be the manner in which GPs work with varied providers and new Commissioning Support Units (22 regional organisations that will provide a combination of business intelligence, technical advice and support for procurement, HR, legal and IT functions)

Richard Vize, Guardian journalist and former Health Service Journal editor, has said that most of the CCGs established and authorised “have demonstrated a strong clinical focus, and are showing early signs of being ready to engage effectively with patients and communities”. If such assessments are correct and likely initial teething problems often seen in large-scale reforms can be worked through, then this does offer hope that the new commissioning structure could make services somewhat more diverse and patient-centred.