What does the NHS’s long-term plan mean for clinical commissioning groups? Now that we’ve had a chance to start digesting, is this a recipe for success? As part of our NHS Voices blog series about the long-term plan, Sara Bainbridge, head of policy and delivery at NHS Clinical Commissioners discusses the plan’s strengths and weaknesses for clinical commissioning groups.
Clarifying the end point
Firstly, a helpful ingredient from the long-term plan (LTP) is that there is now some clarity on where clinical commissioning groups (CCGs) are heading. Since their formation in 2012, CCGs have been simmering away, their numbers slowly reducing as they took a fresh look at the populations they covered and how they were working, and in some cases, decided to formally merge. This is also reflected in many more accountable officers taking on several CCGs and adopting new, shared ways of working.
NHS Clinical Commissioners members have said that they have been on the way to ‘strategic commissioning’ for some time – which includes operating at a geography larger than the CCG – as we spelt out in our 2017 publication, Steering towards strategic commissioning. But while they were taking steps to work more collaboratively – as shown in Driving forward system working – and taking a lead in the systems formed by the creation of sustainability and transformation partnerships, it wasn’t necessarily clear what the end product would look like.
Now the LTP has set out that as integrated care systems (ICSs) develop with the aim to cover the whole country by April 2021, there will be ‘typically’ a single CCG for each ICS area. Although we are still unsure how many ICSs there will end up being, and what ‘a typically’ might mean, this does at least mean CCGs are no longer baking blind. We will be working with NHS England and CCGs to make sure these continuing changes make sense for CCGs.
Working hard to do more for less
The LTP and the accompanying planning guidance also set out what CCGs are expected to deliver, and reiterate that CCGs are expected to reduce their administrative costs by 20 per cent by 2020/21 – continuing to do more for less.
As the LTP was designed to show how the welcome investment in the NHS would be spent, it intends to give a new flavour to health – emphasising the importance of primary, community and mental health services and working collaboratively. But how far will CCGs have the chance – or financial headroom – to invest in new developments while making sure the NHS remains sustainable for the future?
What vital ingredients are missing? ‘Place’ and how to tackle integration barriers
As noted in the recent National Audit Office report, there is a tension for CCGs between achieving ‘system’ level working for a larger population and the need to “design local health services that are responsive to patients’ needs, one of the original objectives of CCGs”. The LTP focuses on the ‘system’ level of ICSs but a real gap in the plan is how to retain that link to ‘place’ – the more local geography that CCGs and local authorities tend to work at, and can often be more meaningful to clinicians and their populations. We covered this recently in our joint publication, Shifting the centre of gravity.
It was good to see that NHS England had also captured the potential barriers to achieving collaborative working, and that these reflect what our members have been telling us. We’ve heard that shared responsibility, clear governance, aligned regulation, a fresh look at procurement, and payment reform might all make efforts to integrate smoother. And all of these featured in the LTP one way or another. But it wasn’t clear how these “possible legislative changes” might be tackled – and we’re concerned that relying on the tricky process of pursuing legislative changes in parliament would not be the best way to go. Although cumbersome, in many areas we know that people are already taking steps to work together. So further work from NHS England and NHS Improvement might be the preferred option – in the form of guidance to reassure, changing their approach to regulation, or sharing examples of best practice, like the Mechanisms of collaboration document from last year. We’ll be working hard to make sure the icing on the cake of the LTP is giving all those trying to improve health the best chance of collaborating successfully.
So what now?
We know that CCGs will be working hard with their system colleagues to produce their one and five year plans over the next few months, and that further change is ahead as some work out how they are going to come together to match ICSs. And we will be supporting them translate the technical challenge that is the LTP into improved – maybe even showstopping – health outcomes for their populations.
Sara Bainbridge is head of policy and delivery at NHS Clinical Commissioners. You can follow Sara on Twitter @sarabainbridge and the NHS Clinical Commissioners @NHSCCPress.
This blog is part of a series of responses by the NHS Confederation group on the NHS Long Term Plan. Read more in this series.