CCGs moving towards STP footprints

18 December 2018 Steve Brown

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A review of the role and costs of clinical commissioning groups noted the recent phase of CCG restructuring with increased joint working and some CCGs merging. There have been eight formal mergers of CCGs since 2013 reducing the number from 211 to 195 and more mergers are expected to come into force in April 2019. Some 117 CCGs already have a joint accountable officer, with a number of arrangements mirroring the structure of the local STP.

‘If current trends continue, this seems likely to result in fewer CCGs covering larger populations based around STP footprints,’ the report said. The larger scale is intended to help with planning, integrating services and consolidating CCGs’ leadership capability. But the NAO said there was a risk that commissioning across a larger population will make it more difficult for CCGs to design local health services that are responsive to patients’ needs.

NHS England is expected to set out its vision for NHS commissioning in its long-term plan for the NHS, which was due to be published in December, although there are increasing reports that it will be delayed until the new year.

The NAO said that current restructuring needed to support the NHS for the long term. ‘We have seen almost three decades of change to NHS commissioning,’ said Amyas Morse (pictured), head of the NAO. ‘It would be a huge waste if, in five years’ time, NHS commissioning is undergoing yet another cycle of reorganisation resulting in significant upheaval. The current restructuring of CCGs must deliver balanced and effective organisations that can support the long-term aims of the NHS and deliver a much-needed prolonged period of stability.’amyas-morse1

CCGs spoken to by the NAO see their future as strategic planning organisations, with more operational activities relating to commissioning, such as day-to-day contract management, being subcontracted to provider organisations under an integrated care provider model.

The audit body also said that NHS England’s annual assessment of CCGs revealed a ‘mixed picture’ in 2017/18, with 42% of CCGs rated ‘requires improvement’ or ‘inadequate’. Ten per cent were rated ‘outstanding’ and 48% as ‘good’. As at October 2018, there were 24 CCGs with active directions in place to address issues with performance, financial management and governance.

There are also an increasing number of CCGs overspending against plan. In 2017/18, 75 of 207 CCGs overspent with the total overspend across all CCGs amounting to £213m. This compares with 57 CCGs in 2016/17 and 56 CCGs in 2015/16. However, CCGs have consistently spent less than their funding for running costs.

Allocated running cost funding was £1.35bn in 2013/14 and this was reduced to £1.21bn in 2015/16 – and has been held at this level since. In 2017/18 CCG running costs were £1.1bn – a 7% underspend. Running cost allocations are due to fall by a further 20% by 2020/21.

The report also highlighted CCG problems attracting and retaining high-quality leaders. CCGs say this is due to a reluctance of staff to step up to senior positions; the uncertain future of CCGs; and the lack of access to training and development.

Julie Wood, chief executive of NHS Clinical Commissioners, said the commissioning landscape was evolving, with CCGs already working more efficiently and collaboratively. ‘Any further reorganisation of CCGs must not undermine the efforts happening across the system to transform health and care services for the better,’ she said.

There was a lot of good work to deliver positive health outcomes, despite having to do more with less. ‘It is vital that the clinical commissioners of the future, operating at system and place level, have sufficient resources to allow them to do their job,’ she added.