By David Talbot, Consultant, London
With over a year since their formation it is now legitimate to ask whether clinical commission groups are making a difference. A recent BMA survey shows GPs remain deeply sceptical; but should CCGs be given a chance, or declared a failure and scrapped?
Clinical commissioning groups (CCGs) were set up in April 2013 as part of the coalition government’s changes to the NHS. They were heralded as the flagship reform, devolving power to GPs, improving patient care and increasing local accountability and transparency.
From the start CCGs have had a lot stacked against them. They have been given control of the majority of the NHS budget at a time of acute financial pressure, with little hope of relief in the next few years. Concerns over how CCGs would engage with GPs, who already face challenging workloads, and how the decision-making and then policy implementation would actually work in practice were side-lined as the government’s centrepiece reform was put into practice.
The concept of CCGs is, of course, with merit. Allowing GPs to make decisions based on the needs of people in their communities is eminently sensible. Nobody knows the health landscape of their locale better than the GPs who service it, after all. A report last year, of data collected every six weeks from thousands of clinicians, detected a “definite lift in mood” in GPs towards the new reforms.
But the latest survey of GPs from the BMA will make troublesome reading for those with ownership of the policy. Jeremy Hunt has described CCGs as “working well” however key findings from the BM survey demonstrate;
§ Almost three out of ten GPs believe their local CCG has introduced policies that have adversely affected their ability to care for patients.
§ Barely one in ten GPs feel that they have been given more freedom to make clinical decisions for their patients
§ GPs feel they either have little influence over their CCG or are told what to do by the CCG rather than being asked to contribute their views
§ Two thirds of GPs say that their everyday workload is preventing them from becoming engaged with CCG work
§ Six out of ten GPs feel that being involved in CCGs is adding to their already stretched workloads
This would suggest that as a policy CCGs have not only failed to win the trust of the very people who are meant to be implementing them, but that they are fundamentally failing to deliver higher-quality care.
The fact that there is an election on the horizon further complicates the future of CCGs. Labour are committed to repealing the Health and Social Care Act, and few things will stop GPs from engaging with CCGs faster than the suggestion that they will not exist in their current form for much more than another 12 months. The danger is that those who predict the failure of CCGs, or who actively propose their dissolution, create a self-fulfilling prophecy and prevent CCGs from meeting their – as yet unmet – potential.
CCGs have been in existence for little over a year. In policy terms it is still in its infancy. Given the energy and resources invested in their creation, and the need – now more than ever – for effective commissioning in the NHS, there will be many who will argue they deserve a chance to succeed. And equally as many who will argue any wholesale reorganisation is just around the corner.