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Will CCGs authorise one another?

Dr Mike Dixon on the need for collaboration between groups and the NHS Commissioning Board

The passing of the Health & Social Care Bill will accelerate the process towards the formation of fully fledged Clinical Commissioning Groups as statutory organisations with their own budgets in April 2013. 

Details of the authorisation process will be agreed and published in April this year, when CCGs will be required to confirm their expected application date. 

Applications for authorisation will be invited from July this year with the first applications being confirmed as authorised as early as October this year.

The Clinical Commissioning Coalition (NHS Alliance/NAPC) has been campaigning for greater CCG and primary care clinician involvement in the National Commissioning Board and in all its activities.  It is now well accepted that another clinical commissioner will be involved in the authorisation of each Clinical Commissioning Group. 

The Coalition thought this was essential because otherwise we could face the scenario of Clinical Commissioning Group authorisation being decided entirely, in some cases, by managers associated with PCT and previous commissioning initiatives, which were not always successful and quite different from the commissioning arrangements proposed for CCGs. 

Consequently, it now seems highly likely that a clinician from another CCG will be an adjudicator (among others) for a given CCG's application and be part of any face to face process in a final decision as to whether a CCG should be authorised.  This will have two benefits.

The first is that part of any CCG authorisation will be decided by someone, who is themselves grappling with clinical commissioning in a CCG. 

Furthermore, the 'adjudicating' CCG will themselves be able to learn something from the process of adjudication and have the opportunity of learning about the modus operandi, commissioning arrangements and plans of another CCG. 

Clearly there needs to be a hard edge to this process in as much as those responsible for huge sums of public money need to show that they are capable and up to it.  Equally, the process envisaged seems to be as benign and supportive as it can be.

A recent Coalition poll of CCG leaders revealed that they thought the greatest threat to them being able to carry out their mission was the National Commissioning Board itself. 

Opening up CCG authorisation in this way is a start in allaying those fears.  The NAPC/NHS Alliance Coalition is also pressing for there being a 360 degree assessment process whereby the CCG themselves can assess how helpful their commissioning support and the National Commissioning Board itself has been in supporting their aims. 

The National Commissioning Board has yet to prove that it is connected to clinical commissioning at all levels, from its Board to frontline GPs, and that it will achieve the right balance of localism and centralism.

It has yet to prove that it will have the primary care focus that future commissioning requires or that it will value primary care clinicians (in terms of numbers and level of responsibility) within its midst - given the NHS has tended to see secondary care clinicians as the 'senior service'.

In short, the National Commissioning Board has yet to convince its CCG leaders and its frontline clinicians that it really does intend to enable an NHS that is led 'from the consulting room' rather than from Leeds.  Nevertheless, it doesn't hold all the cards.  It can only succeed in its mission if it has its CCGs and CCG leaders firmly behind it. 

If they are not happy and if they can collectively show their unhappiness then regime change would be inevitable. 

Sit David Nicholson, their chief executive, has said publicly that he looks forward to the first vote of "no confidence" from CCGs and their leaders.  That will show that they have got their feet under the table and mean business.  Hopefully, it won't come to that, but CCGs and their leaders will need a strong representative organisation to champion their work. 

Dr Michael Dixon is a GP in Cullompton, Devon, and chair of NHS Alliance

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