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CCG and NHS England partnerships mostly work well at local level

But CCGs concerned about co-commissioning and level and type of support offered

Caroline White

Thursday, 05 December 2013

At a local level CCGs and NHS England Area Teams are working together well, but this is not yet consistent across the board, and CCG leads have some concerns around co-commissioning, reveals an appraisal of how well NHS England is working.

Last year NHS Clinical Commissioners (NHSCC), which represents CCGs, announced that it would be conducting a locally led appraisal of the body, based on expected behaviours in the emerging relationships between the different parts of the commissioning system.

These focus on common purpose; local leadership and accountability; and honesty and transparency. These were agreed between NHS Clinical Commissioners and their CCG members and NHS England, and set out in Ways of Working

NHSCC subsequently commissioned Ipsos MORI to survey CCG managerial, clinical, and financial leads across England about these relationships, six months in, with the aim of sharing best practice and highlighting where improvements could be made.

Some 273 out of 569 contacted (48%) responded, from 177 out of the 211 CCGs in England.

NHSCC President Michael Dixon commented: “A locally led appraisal of the central structure of the NHS is something that has never happened before and is possibly the most symbolic evidence available of a shift away from centralism and top-down-control.

Our results show that at a local level CCGs and NHS England Area Teams are working together well and are cooperating to get things right. There are clear indications of good working partnerships, but it is not yet consistent and it is vital that across NHS England they work hard to bring up all Area Teams to the standard of the best.”

The IPSOS Mori report showed that the commissioning system is fractured, which is leading to silo commissioning and behaviours.

“The solution has to be joining things up with CCGs, the centre of this process, not NHS England. This is not a pyramid with CCGs at the bottom of a commissioning hierarchy; rather, they are glue that can bring these things together and create the right balances and priorities,” he suggested.

Given the pressures the NHS faced, it was vital that primary care commissioning is properly resourced and that CCGs are enabled to take a more proactive role in it, he said. “CCGs must be given both the responsibility and the resources they need to better join up commissioning of services for patients,” he urged.

NHSCC has today written an open letter to Sir Malcolm Grant, Chair of NHS England setting out what NHSCC sees as the particular areas which warrant priority focus.

These include its role as a direct commissioner of services: CCG leads did not feel there was a shared vision with NHS England for what they were trying to achieve for primary care.

And just one in three respondents felt NHS England offered the support and development needed to maximise CCG potential. Some complained that the level of support offered was “constrictively narrow,” with interventions too prescriptive and “off the shelf.”

The leads also emphasised the structure of primary care commissioning as a significant challenge that needs to be overcome. They felt that roles, responsibilities and accountabilities were not always clear. Some leads said that CCGs are currently driving forward primary care rather than NHS England, and that commissioning should in the future sit with CCGs.

And when it came to direct commissioning, relationships seemed to be less collaborative than for other roles, with CCG leads suggesting that more information could be shared and more could be done to listen to their views.

Amanda Doyle, Co-Chair of the NHSCC Leadership Group and Chief Clinical Officer at NHS Blackpool CCG said: “We appreciate the positive way NHS England has approached this piece of work. However we now need [it] to grab hold of this report and use the findings to drive forward their organisational development.”

She continued: “Parity of esteem in the commissioning system will only come about when the system fully embraces mutual assurance. Until this happens CCGs will continue to see the relationships being one way, with no requirement for NHS England to account for its activities with respect to commissioning primary care and specialised services.”

NHSCC plans to repeat the survey in 2014 to track future progress from this starting point.

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