Major report into Clinical Commissioning Groups published

Researchers have published the first in-depth study into how the government’s planned shake-up of the NHS next year is progressing. 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 April 2013. The Department of Health-funded Policy Research Unit in Commissioning and the Healthcare System (PRUComm) has researched these developments and recently published its first major report about the early development of CCGs.

Download full report [pdf] >>
Download executive summary [pdf] >>


Wave 1 CCGs lessons learnt report

How CCG authorisation works and what CCGs need to know

GP Online | By Neil Durham, 25 September 2012

England’s 212 clinical commissioning groups (CCGs) are embarking on an authorisation process so they can begin work in April 2013 writes Neil Durham.

 Dame Barbara Hakin: ‘The 212 CCGs have a very significant task ahead.’

England’s 212 CCGs are beginning the authorisation process organised by the NHSCB to ensure they are fit for purpose and ready to take on the role in April 2013 previously performed by 152 PCTs. The process, explained below, includes evidence review, moderation, conditions and decisions.

Dame Barbara Hakin, the NHSCB’s national director of commissioning development, explained the process at the board’s recent meeting in Newcastle last week.

She said: ‘Authorisation makes sure clinical commissioners are properly and adequately supported by the board which is assured that they have all the right competencies to ensure they oversee health services for patients and take responsibility for considerable sums of public money.’

Stage 1: Evidence review

Following the site visit, a report will be prepared and shared with the applicant CCG. It will set out the conclusions of the site visit, both in terms of individual outcomes and assessor views of CCG strengths, areas for development and any areas of concern.

Dame Barbara said: ‘The feedback has been very positive. The site visits carried out so far have gone well. The CCGs undertaking the process say it has helped and been useful in terms of organisational development. The 212 CCGs have a very significant task ahead.’

NHSCB chief executive Sir David Nicholson sat in on a site visit in the east Midlands. He said: ‘You’re not allowed to intervene or speak and they will ask you questions as you go along. I thought it was really impressive. The assessors are very good, experienced health service people and the people from outside the health service commented to me that the training they had been given was excellent.’

For those authorisation requirements which have not been met, the report will cover distance from target and any view expressed by the CCG at the visit as to how they were going to meet particular criteria they recognised they didn’t currently meet.

The CCGs will also be made aware that the site visit report will form the basis of the final evidence report (the main difference being the inclusion of their comments) and therefore decision-making on their application.

They will be asked to consider whether there are any areas where they might be able to make rapid progress over the next three to four weeks, as there will be a final opportunity to submit evidence before their application is considered by the NHSCB sub-committee.

The key assessor, local area team director and authorisation sector lead will then prepare a final evidence report. The content should largely be generated from authorisation knowledge management systems and the site visit report.

The final evidence report will set out the recommended outcomes for all 119 criteria; outline any risks and local context which should be taken into account when determining CCG support needed and set out any difference of opinion between the assessors and the CCG over recommended outcomes.

The report will be completed within 13 days of the site visit and will form the key evidence for the moderation and conditions panels and the NHSCB sub-committee.

Stage 2: Moderation

A moderation panel will review the unmoderated conclusions of the assessment team, any disagreements between assessors and applicants over individual outcomes, results of a number of tests to ensure that appropriate quality assurance is in place and consider outliers where a CCG’s result appears at odds with the national trend. The eight-strong panel includes Dame Barbara.

Panel terms of reference

Review the final evidence report for each CCG and approve the assessment of 119 authorisation criteria before passing to conditions panel, and, make recommendations to the NHSCB sub-committee on which CCGs should be fully authorised and which authorised with conditions.

The panel will meet once per month/wave (October 2012-January 2013). There will be two meetings per wave for waves two and three due to the number of CCGs.

Stage 3: Conditions

A separate panel will be convened to consider what support is required where a CCG has not supplied sufficient evidence to meet a threshold for one or more authorisation criteria.

It is a legal requirement that all conditions are accompanied by an offer of support from the NHSCB. Support could include model document/guidance; advice/expertise available to the CCG; specific team inserted to give in-house support; alternative accountable officer appointed; CCG/NHSCB carries out specific CCG functions or all functions removed.

It is anticipated that a condition could be discharged before 1 April 2013 with only limited support from the NHSCB. It is recommended that a standard review date of March 2013 is built into all conditions. The eight-strong panel will be chaired by Ian Dalton, the NHSCB’s chief operating officer.

The panel will also consider whether a CCG should be authorised with conditions, or established but not authorised as a shadow CCG.

The conditions panel doesn’t review judgements made by the moderation panel.

The panel will meet fortnightly for half a day to consider smaller groups of CCGs within each wave.

The panel makes a report and the CCG has a fortnight to comment, including providing any new evidence that obviates the need for a specific condition.

Stage 4: Decisions

Decision letters will need to be issued immediately after the relevant sub-committee meeting to the applicant. Where a CCG has not been fully authorised it will also set out any conditions imposed, support provided and timescale for review of any conditions.

A rectification plan for each CCG that is not fully authorised would be agreed after the NHSCB sub-committee had made the final decision on authorisation status.

The NHSCB would monitor progress against the rectification plan and would determine whether it was appropriate for a condition to be revised or removed based on CCG progress.

Resources for CCGs

NHS Commissioning Board

Resources for CCGs are part of the CCG Learning Network that provides online support, resources and information for proposed clinical commissioning groups (CCGs).

These are resources which may be useful for emerging clinical commissioning groups (CCGs). They include guidance and process documents, toolkits and other information around authorisation, governance, establishment and commissioning support.

CCG Authorisation

CCG Configuration

CCG Development

CCG Engagement

CCG Governance

The following resources have been provided to help emerging clinical commissioning groups as they work towards becoming established. They should be read in conjunction with Towards establishment: Creating responsive and accountable clinical commissioning groups which was published in February 2012.

The resources, which are optional, have been designed to be flexible and to be tailored for local use.  CCGs may choose to use all or certain aspects of each resource, or decide to create their own versions.

Commissioning Intelligence

Commissioning Support

Health and Wellbeing Boards / Working with your Local Authority

 Human Resources

The Pathfinder Journey (older content)

Patient and Public Engagement

 Primary Care Commissioning

Promoting Diversity and Tackling Inequalities



  • View recordings of Barbara Hakin’s webinars for clinical leaders (Requires Java or installation of an ActiveX Control)


CCG learning network:
Directory | Maps | News | Resources for CCGs | Bulletins | Blogs | Good practice | CCG Learning Network events

New era for county’s community health services

An NHS contract for community services was signed on Friday (13 July).

Community health services are currently provided by Suffolk Community Healthcare (SCH), part of NHS Suffolk, and are expected to formally transfer to Serco by the autumn. Between now and that time the process for transferring staff and services will take place.

The change is in line with the national Transforming Community Services guidance from the Department of Health which stipulates that all primary care trusts, like NHS Suffolk, will no longer directly provide community services and will instead commission (buy) these services.

Serco will work with SCH staff to further develop the current range of adult community services, specialist children’s services and community hospitals across Suffolk as well as improve access to services and address the rural needs of the county’s 600,000 patients. Serco will deliver services in partnership with South Essex Partnership University NHS Foundation Trust (SEPT) and Community Dental Services (CDS), an employee owned social enterprise which provides similar services in Bedfordshire.

Julian Herbert, NHS Suffolk’s acting chief executive said: “The contract signing marks a major milestone in the journey towards finding a new provider for community health services in the county. Serco has been carefully selected and we believe they will provide improved care for patients and new opportunities for staff.

“Importantly, the care that patients receive will still be NHS care and community health services will still be part of the NHS.”

Paul Forden, managing director, acute care for Serco said: “We are delighted to have been given this opportunity to deliver NHS community health services and invest in improving the care for people in Suffolk.

“It paves the way for an exciting new delivery model which will place the patient at the heart of the service while empowering clinicians to spend more time caring. By working closely with partners from across the NHS, voluntary and private sector, we believe we can deliver a truly exemplary service which will bring real benefits to the county’s 600,000 patients.

“We look forward to continuing to work closely with colleagues from NHS Suffolk, Suffolk Community Healthcare, SEPT and CDS over the coming months to ensure that both staff and services are transferred smoothly.

“We are already working in partnership with the NHS and the independent sector to deliver a broad range of healthcare services where high standards of patient care and clinical effectiveness are essential.

“We have a substantial presence across East Anglia, with over 1,000 of our people providing a range of local services to the NHS and other national and local government organisations, including the hospitals in Norwich and Braintree and the Anglia Support Partnership”.

Dr Patrick Geoghegan OBE, chief executive of South Essex Partnership University NHS Foundation Trust (SEPT), said: “I welcome the signing of the contract and this landmark partnership between SEPT, Serco, NHS Suffolk, CDS and Suffolk Community Healthcare. SEPT will be working closely with staff, partners and local stakeholders over the coming months to prepare for the formal transfer of staff and services. This will ensure that local services remain local and it’s ‘business as usual’ for staff and their patients with the same services being provided from the same place, by the same healthcare professionals.”

About Serco

Serco is committed to working in partnership with health and social care organisations across the world.  Working in partnership with Mid Essex NHS Trust, for example, Serco is driving initiatives to minimise waiting times for patient referrals and maximise health outcomes at Braintree Community Hospital. Elsewhere Serco has played a central role in developing an innovative partnership, GSTS Pathology, the joint venture with Guy’s and St Thomas’ NHS Foundation Trust and Kings’ College Hospital NHS Foundation Trust to provide pathology services. Serco also provides facilities management and support services for five hospitals treating acutely ill patients and three Community Hospitals and is one of the UK’s largest providers of healthcare services to people in a custodial setting.   Presently Serco is mobilising a 783 bed hospital in Perth Western Australia to deliver an enhanced patient experience and improved levels of productivity. Serco is also a leading provider of occupational health services, supporting the health and wellbeing of over 450,000 employees in the UK.

In the area of children’s services, Serco has worked in partnership with Primary Care Trusts and other healthcare organisations to establish 3,500 children’s centres across the UK.

Serco has also been chosen as the strategic partner to operate the Anglia Support Partnership (ASP) which provides shared services to the NHS and other public sector groups across the UK

The NHS: Will you still need me, will you still feed me, when I’m 64?

Bevan’s Run | 5 July 

It is notable that the BBC has reported that patient charging and rationing of care may be needed in the NHS.
Patient charging in the NHS was always part of this Government’s plans. Lansley’s NHS reform agenda clearly indicated that new patient charges could be introduced in the next parliament. It looks as though this may happen a bit earlier than planned.
This is all part of the wider NHS privatisation agenda and the grim financial situation the NHS finds itself will accelerate this process. Many NHS campaigners predicted that the number of core NHS services would diminish under the pressure of the £20billion NHS efficiency savings programme, known as QIPP or the Nicholson challenge. This will inevitably lead to increased waiting lists and a new market for healthcare insurance, co-payments and direct patient charges. The idea of the NHS providing a comprehensive service free to all is over. That is why Clause One of the Health and Social Care Bill was so important. The Secretary of State has now abolished his legal responsibility to provide this comprehensive service. Changing this clause was a key denationalisation and privatisation lever. That’s what all the fuss was about in the debates. The door to private sector has not only been unlocked, it’s been unhinged. As the public interest lawyer, Peter Roderick stated, “the Health and Social Care Bill provides legal basis for charging and a reduction in services
The BMJ reported on this here.

As GP Clinical Commissioning Groups ration care, Foundation Trusts will see their income streams decline. This will be catalysed by competition with other providers who will enter the market through the Any Qualified Provider policy. Foundation Trusts will be forced to generate income by treating more private patients, facilitated by an increase of the private income cap to 49%. Many FTs will still fail financially and either close completely, merge with other FTs, or be taken over by private management.  The NHS hospital sector will therefore continue to shrink. Some care will go into the community and this is where more private takeover will occur, because private community providers will take on some of this work.

The privatisation process will also occur on the GP side. This is already happening in terms of clinical commissioning support services. However, privatisation of GP services is also occurring. The Any Qualified Provider policy is also coming to General Practice as well as the hospital sector.

This still has to be paid for. The private sector isn’t going to offer its services for free! Moreover, shareholders want to see profits to ensure reasonable returns. None of this will be affordable with current funding predictions for the NHS. This means money will need to increasingly come into the system from outside the State. This means insurance, co-pay and direct payment. This places financial risk directly onto the poorest and most vulnerable in society, who will be left will a minimal core service.  This is clearly the end of the NHS and it was clearly predicted. The public has been swindled out of their national health service.

What is really tragic about this is that the NHS is affordable in the long term. Professor John Appleby’s article in the BMJ was particularly enlightening on this topic. Moreover the NHS was founded at a time of huge national debt, far outstripping current levels. Current debt problems are a false argument for decreasing NHS funding. It will only result in personal debts going up as risk is transferred to the poorest.

In addition Billions of pounds are also being wasted on a divisive market system and yet more billions of pounds that could be invested in the NHS are located in tax havens around the world. What we are seeing is an ideological political attack on the NHS and the welfare state.
In his recent article in the Guardian, Dr Gabriel Scally, who resigned as a DH regional Director of Public Health, got it spot on:
“Financial austerity is being used to dismantle the state”
This is a tragic state of affairs on the 64th birthday of the NHS.

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