Primary care co-commissioning: challenges faced by clinical commissioning groups in England

Imelda McDermott; Kath Checkland; Anna Coleman

doi:10.3399/bjgp17X694325

INTRODUCTION

The English Health and Social Care Act 2012 gave GP-led clinical commissioning groups (CCGs) responsibility for commissioning the majority of healthcare services for their registered population. However, responsibility for commissioning primary care services was given to a new national body, NHS England (NHSE),¹ to avoid conflicts of interest¹ and because of a perceived need for a standardised and consistent approach to commissioning.² It soon became apparent that NHSE was struggling to move beyond a transactional approach to commissioning, focused on payments and contract management. When Simon Stevens took over as the Chief Executive of NHSE (April 2014), he advocated transferring responsibility for commissioning primary care services from NHSE to CCGs. Two years on, how have CCGs responded to their new responsibilities and what challenges do they face?

WHAT IS PRIMARY CARE CO-COMMISSIONING?

Co-commissioning is intended to support the development of integrated out-of-hospital services based around local needs. The scope of co-commissioning in 2015–2016 covers only general practice services, including: managing practice contracts; commissioning enhanced services and local incentives; establishing new GP practices; and approving practice mergers. It excludes individual GP performance management.

There are three possible levels of responsibility: greater involvement — CCGs have ‘influence’ in shaping primary care; joint commissioning — CCGs share responsibility with NHSE regional teams; and delegated authority — CCGs lead primary care co-commissioning. The policy intention is for all CCGs to ultimately take on delegated responsibility. However, in April 2015 a large proportion (87 of 209 CCGs) opted for joint commissioning, due to uncertainty over what co-commissioning would involve. One year on (April 2016), …

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