Moving towards strategic commissioning: impact on CCG as membership organizations.

Moving towards strategic commissioning: impact on clinical commissioning groups as membership organizations.
J Health Serv Res Policy. 2019 Apr 16:1355819619842272. 

Objective: This paper aims to explore the nature of clinical commissioning groups (CCGs) in England as membership organizations. Utilizing the concept of meta-organization as a lens, we discuss the impact that this organizational form might have on CCGs’ ability to become ‘strategic commissioners’.

Methods: We used a longitudinal qualitative approach to explore the adoption and implementation of primary care co-commissioning. The study was undertaken between May 2015 and June 2017 and included interviews with senior policy makers, analysis of policy documents, two telephone surveys, and case studies in four CCGs nationally.

Results: CCGs operate as membership organizations with closed boundary and low stratification, whereby a consensus or majority needs to be reached by members when activities impact on membership or the CCG’s constitution. While CCGs should move towards a more strategic commissioning role that is focused on local priorities agreed by their members, they are faced with a complex system of accountabilities and responsibilities, which makes this difficult to achieve.

Conclusions: The nature of CCGs as membership-based meta-organizations has the potential to both help and hinder CCGs in becoming strategic commissioners. The complexities in accountability and governance that the membership approach introduces, and the potential difficulties that CCGs face with competing meta-organizations, raises questions about the future of CCGs as membership organizations.

Making strategic commissioning work: Lessons from home and away

Making strategic commissioning work: Lessons from home and away
NHS Clinical Commissioners 13 December 2017

• Lessons drawn from research and international models (primarily of high performing place-based systems of care in New Zealand, Sweden, Spain and the United States ) to support understanding of the developing strategic commissioner role, and the enablers to create a smooth transition towards it.

Steering towards strategic commissioning: Transforming the system

Steering towards strategic commissioning: Transforming the system
NHS Clinical Commissioners 27 September 2017

• Analysis, informed by a survey and interviews with CCG leaders, setting out CCGs’ vision for the future and what they need to get there at pace so they can deliver more for patients.
• The four main ways in which the landscape is developing are:
• CCGs operating across larger footprints as strategic health commissioners using STPs as a key vehicle for delivery;
• integration of healthcare commissioning with local authorities;
• developing an accountable care system;
• developing integrated delivery models such as accountable care organisations.

Supporting strategic commissioning: Collaborative working between CCGs and AHSNs

Supporting strategic commissioning: Collaborative working between CCGs and AHSNs
NHS Clinical Commissioners, AHSN Network May 2017

• This briefing further explores how CCGs can work with Academic Health Science Networks  (AHSNs) to support local strategic commissioning and provides a series of tips for CCGs when doing so.
• Brief case studies including
• Supporting innovation in sustainability and transformation partnerships East Midlands CCGs – East Midlands AHSN
• Reducing the cost of anti-coagulant treatment NHS Newcastle Gateshead CCG – North East and North Cumbria AHSN
• Improving the neurorehabilitation pathway North West London CCGs – Imperial College Health Partners
• Low cost care coordination Kent CCGs – Kent Surrey Sussex AHSN
• Healthier You: The NHS Diabetes Prevention Programme London CCGs – Health Innovation Network (South London AHSN)
• Reducing strokes due to atrial fibrillation East Lancashire CCG – North West Coast Innovation Agency
• The Scarred Liver Project East Midlands CCGs – East Midlands AHSN
• Accelerating understanding to drive population health improvement in the London Borough of Newham Newham CCG – UCLPartners
• Data and analytics to predict unplanned hospital admissions and reduce A&E admissions Somerset CCG – South West AHSN

Strategic direction - Manchester locality plan

Strategic direction - New locality plan for Manchester health and social care services
Central Manchester CCG Board paper, July 2016

• This paper outlines the three ‘pillars’ of the Manchester locality plan, namely-
• A single, integrated commissioning function 
• A Local Care Organisation providing out of hospital care 
• A single hospital service for Manchester
• The leadership of the 3 CCGs and MCC have agreed and implemented the establishment of a Joint Commissioning Executive  which includes the chief officers of the three CCGs and the Strategic Director of Adult Social Services
• Deloitte will carry out an independent option appraisal to consider the benefits of more formal, integrated organisational and management models. Their report will be considered early August.

Strategic place-based "systems of care" is the future of NHS commissioning

Place-based systems of care: A way forward for the NHS in England
Kings Fund 12 November 2015

• This paper proposes a new approach to tackling growing financial and service pressures felt by the NHS, arguing that NHS organisations need to establish place-based ‘systems of care’ in which they collaborate with other NHS organisations and services. Key to this approach is the development of strategic commissioning based on footprints much bigger than those typically covered by CCGs today.
• “Fundamental changes to the role of commissioners are needed to support the emergence of systems of care. Commissioning in future needs to be both strategic and integrated, based on long-term contracts tied to the delivery of defined outcomes. Scarce commissioning expertise needs to be brought together in footprints much bigger than those typically covered by CCGs, while retaining the local knowledge and clinical understanding of general practitioners .”
• "The starting point in establishing place-based systems of care is to define the population served and the boundaries of the system."
• “The case for strategic commissioning rests on the failure of commissioning to make a major impact in the NHS and the need to use scarce expertise as effectively as possible, not least to ensure that place-based provider collaborations are mirrored by a level of commissioning expertise that it is simply not possible to provide in more than 200 CCGs.”
• “Strategic commissioning will require thoughtful evolution towards a system in which the clinical expertise and local knowledge of CCGs are retained and where NHS commissioning is based on footprints much bigger than those typically covered by CCGs today.”
• The report describes existing examples of work to establish place-based systems of care on a more formal basis from across the NHS including York, Solihull, Isle of Wight, Morecombe Bay and Northumberland.