PAC: CCGs must step up game

11 Mar 19

Bodies commissioning health services must improve their performance as they start to cover wider areas as part of the NHS ten-year plan, a group of MPs has said.

The number of Clinical Commissioning Groups will “reduce significantly” by 2021 as part of the NHS Long Term Plan, the Public Accounts Committee has noted.

Health service quango NHS England rated 42% (87 of 207) of CCGs as ‘inadequate’ or ‘requiring improvement’ in 2017-18.

Chair of the PAC Meg Hillier said: “Standards must improve significantly as CCGs take on the commissioning of services across larger populations.”

The committee also called on commissioning groups covering wider areas to communicate with local GPs so they continued to understand the needs of communities.

There is a risk that CCGs will lose touch with the needs of their local populations as they commission services across larger populations,” the committee said in a report released last week.

“It is vital that CCGs, in whatever form, understand the needs of their local populations and have good links with local GPs.”

The MPs directed NHS England to tell them by the end of this year how many commissioning bodies there were likely to be in 2021 as it was currently “not clear”.

CCGs will reduce in numbers as Integrated Care Systems – where local government and NHS bodies work closely together – become more prevalent, the PAC highlighted. The Long Term Plan, announced at the start of this year, aims for ICSs to cover the whole of England by 2021.

Although the committee endorsed the move to more integrated planning and commissioning of health services, it added it was “important not to lose sight of the need for robust accountability structures which make it clear who is ultimately responsible for planning and commissioning decisions”.

CCGs are accountable to NHS England but ICSs are non-statutory partnerships and do not have one overall regulator, the report pointed out.

“We are concerned that, as ICSs develop, accountability systems will be weakened and the performance of individual CCGs will become less transparent,” it said.

ICSs have developed from the 42 Sustainability and Transformation Partnerships. The ICSs foster closer collaboration between the services than STPs.

The PAC called on NHS England to tell it by the end of this year how many ICSs there would be by 2021 and how they would be regulated.

Since NHS commissioning was introduced in the early 1990s there have been several changes to the structure.

CCGs, responsible for planning and commissioning most of the hospital and community NHS services in their local areas, took over from primary care trusts in April 2013. There have been eight formal mergers of the commissioning bodies since 2013. In 2018, there were 195 CCGs.

The National Audit Office highlighted the need for NHS commissioning to have a prolonged period of stability, in a report released at the end of last year.

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