Comment / CCGs: building on authorisation

By Cathy Kennedy

Building new systems and organisations is a time-consuming and intense process. And it can put huge stresses on staff as they strive to continue to deliver the day job and support the change process amid significant personal uncertainty.

For many people working in emerging clinical commissioning groups (CCGs) this has been the reality of recent months and the agenda is becoming increasingly complex. Locally across the Humber and North Yorkshire and York clusters, staff from five PCTs are applying for roles in one commissioning support service that will then serve eight CCGs and an NHS Commissioning Board local area team. All of these also need to populate their own structures.

But the new build programme goes beyond staffing issues. The new CCGs will work in a different way to their predecessor commissioning bodies. The council of members will set how the organisation will work. And in many ways having this member-led group at the top level, delegating authority to a governing body, turns on its head the former model of a board and executive team advised by a clinical committee.

So we, along with many other CCGs I am sure, have been spending a lot of time developing our understanding of a membership-led organisation and the role of members. Understandably this construction process is taking a lot of the focus currently, as is the authorisation process itself. And it is important to get it right.

But creating CCGs is not the end point, it is only the beginning. CCGs are being set up to improve commissioning – ensuring services are better designed around patient experience, quality and sustainability. In North East Lincolnshire, we are already detecting an impatience among the members to get on with the real job. They want agendas with less ‘business’ and more time to discuss and improve services. We need to harness this enthusiasm to drive local change, while ensuring they understand that we work within a national system.

Once the doors open on new CCGs, there is a huge agenda ahead. Despite their newness, CCGs need to make mature commissioning decisions, understanding the short, medium and long-term implications of their decisions on services, patients and organisations. And they need to lead their commissioning within an increasingly diverse market place, while responding to the challenging financial environment.

Integrated care is seen as one way to deliver better services and experiences for patients – and to help to meet the £20bn efficiency drive. Providers clearly have a major role in this, but commissioners must set the direction and create the right environment. 

In North East Lincolnshire, we pioneered greater integration in both commissioning and provision of health and social care, with horizontally integrated services now hosted within new social enterprises. But in neighbouring areas, integration is vertical, bringing together community and acute (or mental health) services. It will be interesting to see how the differing approaches fare.

However, there is a danger that the future system could look fragmented from a patient’s perspective, and CCGs will need to get to grips with creating integrated care pathways. We need to look for a range of mechanisms to achieve this. For example, we may need to commission through lead provider arrangements, forcing health economies – whatever their provider configuration – to respond collectively to the delivery of pathways rather than in a piecemeal way.

We will shortly see the first wave of CCGs gain authorisation. There has been a huge amount of effort for those organisations to get themselves ready. And many more in the subsequent waves  will still be in the throes of that effort. But there must be no doubt that the real task – the task of driving improvement in services and value – still lies ahead.

Cathy Kennedy is chair of the HFMA’s Commissioning Finance Group and deputy chief executive of North East Lincolnshire CCG