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CCGs flawed because of multiple accountability

Too many bodies have control of CCGs with conflicting agendas

Adrian O'Dowd

Friday, 13 December 2013

GPs on clinical commissioning groups (CCGs) could struggle to fulfil their commissioning role well because they are answerable to too many bodies that have potentially conflicting agendas, says research published in the online journal BMJ Open.

UK researchers said the accountability regime for GP-led CCGs, which took over commissioning responsibility for healthcare from PCTs in April of this year, is more complex than in the previous system.

One of the aims of the NHS reforms was to boost the accountability of those responsible for commissioning care for patients while also giving them greater autonomy than their predecessor organisations had enjoyed.

Researchers, led by the Centre for Primary Care, at the University of Manchester, set out to look at the accountability relationships of eight CCGs, to get a snapshot of how these were developing.

Between September 2011 and June 2012, they interviewed 91 people – including GPs, managers, and governing body members – attended different types of meetings for a total of 439 hours, and analysed a wide range of documents.

The researchers said CCGs were externally accountable to NHS England (the government); Monitor (the regulator), health and wellbeing boards (public health and social care); the local Health Watch (patients); the public; LMCs (GPs); and the local authority Overview and Scrutiny Committee (public health).

They were also internally accountable to the CCG governing body, member practices and locality groups.

Based on the evidence they gathered, the authors concluded that CCGs were more accountable than PCTs had been, but they were “at the centre of a complex web of accountability relationships, both internal and external”.

“However, whether this translates into being more responsive, or more easily held to account, remains to be seen,” they said.

They said that previous research indicated that complex accountability arrangements tended to generate confusion and where organisations were accountable to multiple audiences, the interests of these audiences could differ, generating unintended consequences.

CCGs’ accountability relationship with NHS England was the only one so far that was clearly defined and where sanctions applied, they added, in sharp contrast to the accountability to other external bodies, such as health and wellbeing boards, which was much weaker.

Although CCGs’ accountability to the regulator could be enforced by competition law, it was unclear how this would work in practice, they said.

CCGs could choose to satisfy their public audiences rather than the government and possibly avoid “hard decisions in the face of public opposition” warned the authors.

They concluded: “This early study raises some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing (or conflicting) agendas, and the lack of clarity over the operation of sanction regimes.”


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