Clinical Commissioning Group (England)

Clinical Commissioning Group (England)
Name	Clinical Commissioning Group (England)
Formation	2013
Predecessor	Primary Care Trusts
Successor	Integrated Care Board (2022)
Type	Statutory body
Headquarters	Various in England
Region served	England
Leader title	Clinical Chair
Parent organization	NHS England

Clinical Commissioning Group (England) Clinical commissioning groups were statutory NHS bodies in England established by the Health and Social Care Act 2012 to commission healthcare services for local populations. They replaced Primary Care Trusts and operated under the oversight of NHS England until many functions transferred to Integrated Care System bodies and Integrated Care Board (England) arrangements. CCGs interacted with a range of organisations including NHS Foundation Trusts, NHS Trusts, Care Quality Commission, local authorities, and Healthwatch.

History

CCGs were created following policy decisions associated with the Health and Social Care Act 2012 under the Coalition government (United Kingdom) led by David Cameron and Nick Clegg. The reorganisation sought to give clinicians greater control, drawing on models such as clinical commissioning in New Zealand and commissioning arrangements in Australia while replacing structures like Primary Care Trusts and regional offices of NHS England. The first CCGs took statutory responsibility in April 2013, with prominent early examples including NHS South Norfolk Clinical Commissioning Group, NHS Manchester CCG, and NHS Camden CCG. Subsequent reforms, influenced by reports like the Five Year Forward View and the NHS Long Term Plan, led to consolidation and the eventual emergence of Integrated Care Systems and Integrated Care Boards (ICBs) by 2022.

Structure and governance

CCGs were membership organisations composed of GP practice members represented by clinical leaders such as GP chairs and a governing body including secondary care doctors and registered nurses. Governance arrangements referenced statutory frameworks like the National Health Service Act 2006 and regulatory oversight by the Care Quality Commission and NHS England. Boards often included lay members drawn from Healthwatch England networks and partnership representatives from local authorities such as county councils and unitary authorities. Major CCGs, such as NHS North West London CCG, developed federations and alliances with Clinical Senates and clinical networks linked to specialist providers like Great Ormond Street Hospital and Royal Free London NHS Foundation Trust.

Roles and responsibilities

CCGs were responsible for commissioning secondary care from organisations including NHS Foundation Trusts and independent sector providers like Bupa and Circle Health Group. They commissioned community services from providers such as Serco and mental health services from trusts including Camden and Islington NHS Foundation Trust and South London and Maudsley NHS Foundation Trust. CCGs planned services in partnership with local authorities, engaging with Public Health England priorities and collaborating on joint strategic needs assessments alongside directors of public health. They held contracts with ambulance services such as London Ambulance Service and worked with specialised commissioning arrangements managed by NHS England Specialised Services.

Commissioning processes

CCGs employed needs assessment methodologies informed by data from Office for National Statistics and tools used by organisations like NHS Digital and Public Health England. Procurement processes adhered to frameworks including the Public Contracts Regulations 2015 and often involved competitive tendering used in cases involving providers such as Virgin Care and Ramsay Healthcare UK. Commissioning cycles incorporated clinical pathways inspired by guidance from National Institute for Health and Care Excellence and collaborative planning with Academic Health Science Networks. CCGs also managed continuing healthcare and used frameworks similar to those developed by NHS England for specialised commissioning.

Performance and accountability

CCG performance was monitored through metrics used by NHS England and inspected by the Care Quality Commission, with performance indicators aligned to targets from initiatives like the NHS Constitution (United Kingdom). High-profile performance issues involved waiting-time standards for organisations including University College London Hospitals NHS Foundation Trust and Royal Free London. Accountability mechanisms included annual reporting to NHS England and governance scrutiny by local Overview and Scrutiny Committee panels within local authorities. In some areas, judicial reviews and legal challenges referenced case law such as rulings in Administrative Court (England and Wales).

Funding and budgets

CCG allocations were determined through resource distribution formulas developed by NHS England and influenced by demographic data from the Office for National Statistics and indices such as the Index of Multiple Deprivation. Budgets funded acute services provided by trust groups like Guy's and St Thomas' NHS Foundation Trust and community providers including LeDerCare. Financial regimes required compliance with statutory duties under the National Health Service Act 2006, with reporting to NHS Improvement and financial pressures contributing to mergers and collaborations exemplified by CCGs in Greater Manchester and Merseyside.

Criticisms and controversies

CCGs attracted criticism over procurement controversies involving companies such as Virgin Care and Circle Health Group, legal disputes brought to the High Court of Justice and concerns raised by campaign groups including Keep Our NHS Public. Critics highlighted fragmentation risks cited by commentators and organisations like The King's Fund and Nuffield Trust, while supporters pointed to clinical leadership benefits advocated by entities like the Royal College of General Practitioners and British Medical Association. Debates over conflicts of interest, exemplified in cases reviewed by NHS Protect and parliamentary committees including the Health Select Committee, influenced subsequent reforms toward Integrated Care Systems.

Category:NHS (England)