MPs have warned that as the number of Clinical Commissioning Groups (CCGs) are highly likely to reduce in the next few years as part of changes to NHS commissioning arrangements, these bodies will have to improve their performance.
In a report* on CCGs published today by the parliamentary public accounts committee, MPs said that the NHS Long Term Plan was the latest development in three decades of changes to the structure of NHS commissioning organisations.
The Long Term Plan sets out the intention for Integrated Care Systems (ICS) to cover the whole of England by 2021, which will result in a significant reduction in the number of CCGs.
MPs said the change in structures within the NHS in England since 2012 had been particularly “confusing and rapid”, making it challenging for taxpayers to understand who in their local area was accountable for health spending and performance.
The report says: “The alphabet soup of health bodies that has grown up has done so, in many instances, without clear governance and accountability.”
Many CCGs were currently underperforming and this would need to improve as they took on the responsibility for commissioning services across larger populations, warned the MPs.
In 2017-18, 42% of CCGs were rated either “requires improvement” or “inadequate” and although performance ratings had improved since 2015-16, the assessment methodology had changed, meaning a direct comparison was not possible.
NHS England currently deemed 24 CCGs to be failing, or at risk of failing, but it was working with NHS Clinical Commissioners to provide support to CCGs to help them improve.
“We are concerned about the impact on patient outcomes if the performance of CCGs does not improve, especially as they become responsible for commissioning services across larger populations,” said the MPs.
Therefore they recommended that NHS England should report back to them by the end of 2019 on the actions it had taken to ensure all CCGs were performing effectively and had high quality leadership.
It was unclear how many CCGs there would be by 2021 or the final structure of ICSs, but it was anticipated that there would be one CCG for each ICS.
There was also a risk that CCGs could lose touch with the needs of their local populations as they commissioned services across larger populations.
It was vital that CCGs understood the needs of their populations and had good links with local GPs, but as CCGs became responsible for commissioning services across bigger populations there would be a tension between commissioning at a larger scale while maintaining an understanding of the health needs of local populations.
NHS England is considering a three-tiered approach to planning and commissioning services across a population and also at the development of GP networks to help plan and reshape services at a local level.
The MPs recommended that when reporting back at the end of 2019, NHS England should set out the actions it had taken to ensure that local GPs had input into CCGs' decisions and that CCGs remained focussed on the needs of local populations.
Committee chair Meg Hillier said: “Time and again our committee has seen reforms that are driven by good intentions fail to result in positive outcomes.
“That fate must not befall the latest changes to commissioning in the NHS, which need to deliver frontline benefits, safeguard public money and avoid further muddling lines of accountability at local level. This will be a challenge. Standards must improve significantly.”
*Clinical Commissioning Groups. Public Accounts Committee, 8 March 2019