Changes To The Structure Of The NHS: Part 1


Clinical Commissioning Groups 18 Months On

In June 2014 I looked briefly at the history of the NHS in order to remind us of its purpose. Now is a good time to take stock and reflect on some of the changes that we have seen over the past 18 months. This is the first of two articles looking at these changes and it focuses on Clinical Commissioning Groups. The second article will provide a summary of the groups that the CCGs are working with.


Clinical Commissioning Groups

The CCG authorisation process established CCGs as statutory bodies on 1 April 2013; they replaced Primary Care Trusts as the commissioners of most local healthcare services funded by the NHS in England.

What Is The CCG Budget?

CCGs are clinically-led organisations at the heart of the NHS system and they are responsible for the commissioning of health services in their designated communities. They now control around two-thirds of the NHS budget and have a legal duty to support quality improvement in general practice.They are responsible for £65 billion of the £95 billion NHS commissioning budget.

What kinds of services do they commission?

  • Most hospital care
  • Rehabilitation care
  • Urgent and emergency care
  • Most community health services
  • Mental health and learning disability services

Regional Provision

Obviously there are regional variations in how CCGs across England are working. By way of example, the area where I live is served by the North Lancashire CCG, 13 GP practices make up this group. The member practices have delegated responsibility to the Governing Body of NHS Lancashire North CCG, which has a Clinical Chair (a local GP). The Group aims to ensure that it operates efficiently, acts in the best interests of the population and commissions high quality, safe and effective health services that meet the needs of residents in Lancaster, Morecambe, Carnforth and Garstang (approximately 149,000 patients). It is responsible for commissioning planned and emergency hospital care, rehabilitation, most community services and mental health and learning disability services. To do this the Group states that it uses local clinical expertise, evidence of good practice and the experience of patients who use the services commissioned.

In 2013/2014 it had an allocated budget of £193.32m for commissioning NHS services for the local community and £3.73m for its running costs.

The NHS Lancashire North CCG will work with a new consumer body called Healthwatch England which has been set up. Local Healthwatch bodies have replaced the Local Involvement Networks (LINks). They will promote public engagement in the NHS, comment on changes to local services, act as advocates for complaints, and deliver advice across health and social care.

Groups The NHS North Lancashire CCG Are Working With

The CCG works with a range of statutory and non-statutory partners, organisations and multi-agencies including:
  • The Lancashire Health and Wellbeing Board
  • The Lancaster Health & Well-being Partnership
  • NHS Cumbria CCG and the other Lancashire CCGs
  • Local healthcare services and providers
  • Mental health services
  • Children’s services
  • Healthwatch
  • Voluntary sector organisations

CCGs Accountable To NHS England:

Under the Health and Social Care Act, NHS England makes an annual assessment of CCGs each financial year and publishes a summary report.

Assurance Framework

There is a statutory requirement on NHS England to oversee assurance - the assurance framework sets out six broad ‘assurance domains’ that reflect the key elements of an effective clinical commissioner. The domains cover patient and public involvement; partnership working; CCG leadership; CCG governance; and ensuring that patients are receiving clinically commissioned high quality services that are delivering better outcomes for patients.

Do CCGs have to consult patients and the public about their commissioning decisions?

CCGs have a duty to involve the public in commissioning decisions (under the Health & Social Care Act, 2012). CCGs need to engage patients and the public in the locality in the commissioning process. The duty is similar to that previously imposed on PCTs. CCGs are required to involve patients (actual/potential) in the:
  • Planning of commissioning arrangements
  • Development and consideration of proposals for changes in commissioning arrangements where implementing the proposals would have an impact on the range or manner of delivery of services
  • Decisions affecting the operation of commissioning arrangements that, if implemented, would have a significant impact.
The NHS Lancashire North CCG Governing Body has two lay members and it meets throughout the year in public (anyone can attend). The Clinical Chair and Chief Officer are available to meet members of the public for thirty minutes before the beginning of each meeting of the Governing Body to discuss healthcare issues.

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