The big switch: what the change to CCGs could mean – part 2

Elliot Bidgood, 2 April 2013

As I commented in advance last week, yesterday was a big day for the NHS – 152 Primary Care Trusts (PCTs) and ten Strategic Health Authorities ceased to exist and 211 Clinical Commissioning Groups (CCGs), overseen instead by NHS England (also known as the NHS Commissioning Board), took charge of the commissioning of health services. Many have referred to this change as the largest structural reorganisation in the 65-year history of the NHS – it has thus attracted substantial press attention and comment over the Easter weekend.

The reforms are expensive (an estimated £1.5bn), have involved a huge amount of work and may ultimately simply prove to be a distraction. As I discussed last week, substantial issues remain. Several more of these have been highlighted in the past few days:

• Though all CCGs have now taken over commissioning, only half reached “full authorisation” by April 1^st and a quarter face substantial operational restrictions from NHS England. These will be reviewed in June
• Uncertainty has been reported among NHS staff currently transitioning to new jobs in CCGs and others have warned about a loss of “corporate memory”, due to some experienced NHS staff not taking new jobs at all
• While the reforms aim to empower GPs, the GP magazine Pulse found that that 55% do not yet feel more involved in commissioning decisions in their new CCG (36% did feel more involved). Pulse also reported substantial anxieties among GPs about the centralised “relationship of command and control” between the Commissioning Board and CCGs and warned that “many practices feel they have been given accountability without much power”. However, in a positive sign, 83% of GPs in the Pulse study felt that CCGs were pushing them to improve their performance – 57% felt somewhat or very pushed

In the end, more important may be the competition elements accompanying the reforms. Studies have tended to show that areas of the NHS where choice and competition took root more rapidly during the 2000s saw faster rises in clinical standards. Further, from a comparative standpoint, developed nations that harness mixed provision and a consumer ethos within their national universal health systems tend to post strong results in international rankings of healthcare quality. In a sense, this vindicates Alan Milburn’s 2001 argument that “Where we need to get to is a position where the NHS is no longer a monopoly provider of care…” and so we must be careful to moderate the currently negative tone of public discussion about the role that diverse provision can have in the NHS.