London School of Hygiene & Tropical Medicine

The reorganisation of the NHS in England, which will see new Clinical Commissioning Groups (CCGs) – led by GPs – take responsibility for spending some £60 billion of public money, has generated much debate and discussion over the last two years. These groups were established during 2012 and have been preparing their organisations and plans ready to take on their new functions from next April.

The Department of Health-funded Policy Research Unit in Commissioning and the Healthcare System (PRUComm) – which is a collaboration between the London School of Hygiene & Tropical Medicine, the University of Manchester and the University of Kent - has researched these developments and today publishes its first major report about the early development of CCGs.

“The study provides the first detailed evidence about the way in which aspirant CCGs have been developing and meeting the challenges associated with their new roles,” said Dr Kath Checkland, from the University of Manchester, who led the research. “We carried out detailed qualitative case studies in eight developing CCGs across England from Sept 2011-June 2012, as well as conducting web surveys of all developing CCGs at two points in time – December and April. This study provides a comprehensive look at what is happening as the most significant NHS reorganisation in a generation unfolds.”

The Unit’s Director, Stephen Peckham, Professor of Health Policy at the London School of Hygiene & Tropical Medicine, said: “The current NHS changes are the most significant since 1948 and it is important to capture this process of change. This study provides a unique insight into the development of the new Clinical Commissioning Groups and how GPs and other health services staff are coping with these changes.”

Key findings include:

• There has been a great deal of activity and enthusiasm from leading GPs on the ground as they engage with the new structures. Most of those taking up leadership positions have acted as leaders in the past in other organisations such as Primary Care Trusts (PCTs) or Practice Based Commissioning (PBC) groups.
• The research period was one in which there was considerable flux and change on the ground, as developing CCGs settled towards their final configurations. The influence of past history was much in evidence, with many CCGs setting themselves up to mirror past administrative groupings such as Primary Care Groups, PCTs or PBC groups.
• At the time of the research, developing structures were complicated and multi-layered, as developing CCGs worked out how relationships between governance structures, operational responsibilities and grass-roots’ members would work in the longer term
• Local Health and Wellbeing Boards (HWB) are developing at different speeds across the country. Developing CCGs are engaging with their local government partners to establish new ways of working. The report highlights issues that have arisen in this process.
• Developing CCGs in the study showed considerable enthusiasm for engaging with both commissioning and contracting, working alongside PCT colleagues as they prepare to take over responsibility in April 2013. The report discusses the experiences of developing CCGs as they begin to engage with their local Commissioning Support Units.

The Policy Research Unit in Commissioning and the Healthcare System (PRUComm) provides evidence to the Department of Health to inform the development of policy on commissioning.

The full report is available at www.prucomm.ac.uk