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Number of CCGs continues to shrink

Published on 23/10/11 at 12:00am

The number of regional groups preparing to take over control of the NHS in England is rapidly shrinking, as the scale of their task is made clear.

Clinical Commissioning Groups, formerly known as GP consortia, will start to assume control of budgets in England from 1 April 2013, and will be at the core of heavily re-designed health service

The first ‘pathfinder’ groups were named in September 2010, and by the new year more than 90% of England’s NHS was covered by GP consortia. Crucially, doctors were told to set up their own groups and determine their own boundaries, which saw groups of all shapes and sizes hastily formed in a matter of months.

By March the government declared that a total of 380 GP commissioning consortia had already been formed. But in recent months this figure has rapidly declined as the government has been forced to reverse its earlier guidance on the size of the groups.

The ‘listening exercise’ conducted in April and May, exposed concerns that many of the new GP consortia would be too small to handle the legal and financial functions they would need to carry out. Following the consultation, new modifications and checks on the powers of GP consortia were introduced, and they were renamed Clinical Commissioning Groups.

By August the number of CCGs had dropped to 331, and little over a month later, this has shrunk again to 253 groups.

There is huge variation in approaches across England. In Cambridgeshire, there were once six pathfinder groups, but now these look set to merge into one county-wide CCG.

Simon Hambling, chair of Cambridgeshire’s GP senate recently told the Health Service Journal: “They moved the goalposts quite significantly for us. There’s been some wasted time, a dashing of some people’s expectations. People thought there would be a lot more freedom to operate which is just not going to be the case.”

Despite the mergers, health service experts say many undersized CCGs remain, but the government is not yet compelling them to form larger groups.

The most extreme example of this is Red House CCG, a single practice in Hertfordshire which was among the first wave of pathfinders.


Bureaucracy fears

Meanwhile a new survey reveals many CCGs are concerned by the amount of bureaucracy they face and feel they don’t have enough support. According to the new NHS Alliance survey, CCGs want more involvement at a local level, and it shows that over a third have not been involved in shaping commissioning support that has been put into place.

Julie Wood, director of the NHS Alliance Clinical Commissioning Federation, said there remained a lot more work to be done on shaping the commissioning process.

“We need to ensure that all CCGs are involved locally in shaping the support available to them and, equally important, that they are aware of the choices available and are able to choose according to their specific needs.”

Although 47% of CCGs said they were fully involved in commissioning, 32% said they were not and a further 21% were ‘not sure’.

The survey had 131 respondents and when asked about the style of working with the NHS Commissioning Board and transitional PCT clusters, most CCGs said it was too centralist (44%) and too prescriptive (19%), and only 18% found it about right.

One respondent said: “There are too many meetings focused on structures with no relevance to empowering CCGs or transforming clinical care ... this is not a liberating process - it is painful, slow and bureaucratic.”

However, despite the issues raised by the survey 60% of CCGs still said they were confident they would be ready to assume responsibility for commissioning health services from April 2013.

The Department of Health has now released a document detailing the standards CCGs must meet in order to assume power.

The document, Developing Clinical Commissioning Groups - Towards Authorisation lays out the pathway to authorisation, will be granted by the new NHS Commissioning Board. Aspiring CCGs will undertake a risk assessment and be given help to gain the commissioning experience which will enable them to create a track record with local authorities.

The new plans build on the principle that CCGs will only be authorised to take over when they are judged ready, a departure from the original plans for a ‘big bang’ in which CCGs would take control at the same time across England on 1 April 2013.

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