Accountability and performance management arrangements for CCGs

This report explores the accountability and performance management arrangements for CCGs and looks at the implications of  STPs and accountable care systems for these| The Nuffield Trust

The NHS has developed systems to hold both providers and commissioners of NHS services to account. These have arguably become more complex with the introduction  of 44 sustainability and transformation partnerships (STPs). This report from the Nuffield Trust draws on analysis and insights from the current system, and explores the challenges and opportunities presented by STPs for accountability in the NHS. It is based on 13 interviews with senior CCG leaders and NHS England policy makers which took place in September 2016.

The report also explores how commissioners and providers respond to different approaches to accountability and performance management. The report then considers the implications of this learning for the future development of STPs, accountable care organisations and accountable care systems.

Full report: A two-way street: what can CCGs teach us about accountability in STPs?

Related Nuffield Trust blog: Staying accountable: NHS leadership in hard times

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Financial challenges facing the NHS

The Healthcare Financial Management Association (HFMA) has published NHS financial temperature check: finance directors’ views on financial challenges facing the NHS in England. 

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This briefing draws on the responses of finance directors of trusts and foundation trusts and chief finance officers of CCGs.  It finds the financial performance of the NHS remains under significant financial pressure.

Trusts reported a combined deficit of £791m in 2016/17, after receiving additional funds of £1.8bn from the sustainability and transformation fund (STF).

The performance of CCGs, based on month 11 forecasts, looks better than that of trusts with a forecast in-year underspend of £250m, but this is after the release of the £800m risk reserve to CCGs’ bottom line.

Full document: NHS financial temperature check – briefing July 2017

Additional link: NHS Providers

Framework to help CCGs deliver more personalised health care

NHS England has published a guide for CCGs and local authorities on the use of integrated personalised commissioning and personal health budgets.

These are designed to enable a more personalised approach to people’s health and social care. NHS England has made a commitment to ensure that 300,000 people benefit from personalised health and care through integrated personal commissioning by 2018/19, which includes 40,000 people with a personal health budget.

The guide can be viewed here

The future of commissioning

NHS Providers has launched a new publication series “Provider Voices” which promotes the views of leaders from a range of trusts and other parts of the service on some of the key issues facing the NHS.

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The first report Where next for commissioning? includes eight interviews that address concerns including the role of Sustainability and Transformation Partnerships (STPs) and accountable care systems (ACSs), the challenge of integrating health and care commissioning, and the future of the purchaser-provider split.

Related:

 

NHS Commissioning of Specialised Services

This Commons Library briefing paper looks at the commissioning of specialised services by the NHS in England, for patients with rare or complex conditions | House of Commons Library

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How the commissioning process works is set out in further detail, as well as analysis of the financial management and transparency of specialised commissioning, and recent reforms introduced by NICE and NHS England, including reforms to the Cancer Drugs Fund.

The specialised commissioning budget for 2017/18 is £16.4 billion, 14.9% of the total NHS budget, and is set to rise to 15.8% by 2020/21 to reflect the increasing use of new treatments for previously untreatable conditions.

In its 2016 report, the National Audit Office (NAO) highlighted problems that NHS England had experienced in living within its budget. Some of the reasons for this included an underestimation of the budget required to effectively commission services when NHS England took over commissioning responsibility in 2013, as well as a lack of effective data on how services are commissioned on a regional basis, and problems with effective negotiation of prices with pharmaceutical companies.

This briefing paper looks in details at some of the issues highlighted by the NAO, and recent changes to the commissioning process that allow for a greater degree of cost control.

General practitioners’ views of clinically led commissioning

Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years | BMJ Open

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Objectives: The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement.

Results: While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as ‘membership organisations’ but only a minority of respondents reported feeling that they had ‘ownership’ of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do.

Conclusion: CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership.

Full reference: Moran, V. et al. (2017) General practitioners’ views of clinically led commissioning: cross-sectional survey in England. BMJ Open. 7:e015464