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What are clinical commissioning groups?

Learn about what clinical commissioning groups (CCGs) are, what they do, their contribution to health and care and their evolving role.

17 May 2021

Clinical commissioning groups (CCGs) were created following the Health and Social Care Act in 2012, and replaced primary care trusts on 1 April 2013. They are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area. As of 1 April 2021, following a series of mergers, there are 106 CCGs in England.

The NHS expects that CCG functions will be subsumed into integrated care systems over the course of 2021/22, with CCGs ceasing to exist as statutory organisations by April 2022. Until then they remain the organisations that are responsible for getting the best possible health outcomes for their local population. 

This involves assessing local needs, deciding priorities and strategies, and then buying services on behalf of the population from providers such as hospitals, clinics, community health bodies, etc. It is an ongoing process. CCGs must constantly respond and adapt to changing local circumstances. They are responsible for the health of their entire population and measured by how much they improve outcomes.
CCGs are:

  • membership bodies, with local GP practices as the members
  • led by an elected governing body made up of GPs, other clinicians including a nurse and a secondary care consultant, and lay members
  • responsible for approximately 2/3 of the total NHS England budget; equivalent to £79.9 billion in 2019/20
  • responsible for commissioning healthcare including mental health services, urgent and emergency care, elective hospital services, and community care
  • independent, and accountable to the Secretary of State for Health and Social Care through NHS England
  • responsible for the health of populations ranging from under 100,000 to over a million, although their average population is about a quarter of a million people.

Influencing the evolving commissioning system

The commissioning system is continually evolving. NHS Clinical Commissioners represents its members’ views in national debates on the future of commissioning by producing policy briefings, influencing documents and engaging with the most senior leaders in the health sector. 

One of our early influencing documents was Local solutions to national challenges (2015), which put forward a series of key “asks” to give clinical commissioners the freedoms and flexibilities they need to make even more of a difference in transforming healthcare locally. Read more.

Our publication The future of commissioning (2016) set out our vision for the future of clinical commissioning, based on feedback from our members.

More recently, Steering towards strategic commissioning (2017) outlines what CCGs need to support their strategic commissioning ambitions and get there at pace. 

We followed up our 2017 publication with a joint publication with NHS Providers, Driving forward system working (2018), which examined the changing relationship between commissioners and providers in the context of system working. 

Following the publication of the NHS Long Term Plan, our focus has been on influencing the future of commissioning within Integrated Care Systems. The changing face of clinical commissioning (2019) showcases the unique perspective brought by clinical and makes the case for this expertise to be retained when developing integrated systems.

We have also worked closely with our members to respond to consultations on future legislation affecting the NHS (2019), and the future of integrated care (2021).

CCGs and NHS England

CCGs work with closely with NHS England, which has three roles in relation to them:

  • assurance: NHS England has a responsibility to assure themselves that CCGs are fit for purpose and improving health outcomes.
  • development: NHS England must help support the development of CCGs.
  • direct commissioning: NHS England directly commission highly specialised services. In some cases they also commission primary care, though most CCGs have either full or joint responsibility alongside NHS England for this. As co-commissioners, CCGs work with NHS England’s regional teams to ensure joined-up care.

Public health

As local authorities are responsible for public health, CCGs work closely with them through health and wellbeing boards. They work together to achieve the best possible outcomes for the local community by developing a joint needs assessment and strategy for improving public health.

Commissioning support units

Commissioning support units (CSUs) help provide support and services for CCGs such as finance, HR, data management, or contracting. CCGs can buy services from CSUs or to carry them out in-house, whichever they feel is most efficient and appropriate. CSUs are procured by CCGs via the NHS England Lead Provider Framework.