Now that the authorisation process is finished for almost half of CCGs, you may expect them to heave a huge sigh of relief. But you would be wrong.
Not one has been refused so far - although one asked for an extension - but they have not all passed the process with flying colours.
Of the 101 CCGs authorised in waves one and two, only 27 have been authorised without any conditions. For the rest, the majority have been given conditions that consist of extra guidance, and are expected to be fully autonomous come April.
However, there are still a significant number of CCGs that have had more serious conditions laid on their authorisation – level three conditions – that will require Commissioning Board sign-off for certain decisions. An unfortunate three CCGs will have troubleshooters imposed on them by the Board to manage areas where they are not operating satisfactorily.
So in which areas are these CCGs failing? Pulse analysed the figures and found the most common area of concern for the NHS Commissioning Board was in future planning. Almost a quarter – 23 – of authorised CCGs were given level three conditions for the criteria to have a ‘clear and integrated plan’, which includes an operating plan for 2012/13, draft commissioning intentions for 2013/14 and a high level strategic plan until 2014/15.
Similarly, many CCGs – 15 – struggled with the requirement to have a detailed financial plan that delivers financial balance.
This problem with strategic planning is also evident in the fact that nine CCGs were unable to satisfactorily provide evidence that the senior in-house management roles are capable of maintaining strategic oversight with available resources. So it is a lack of experience that is proving difficult, or have they just not had enough time?
Dr Johnny Marshall, the interim partnership development director at NHS Clinical Commissioners, says the areas they are struggling is not a surprise: ‘It is the more complicated end of the spectrum and reflects that maybe PCTs have been struggling with the long-term strategic view. CCGs find themselves in a challenged area financially.’
The reason for this struggle is not complicated, says Dr Michael Dixon, chair of the NHS Alliance and a GP in Devon. ‘We are in an extremely tight financial situation. CCGs are coming into situations where their money has already been spent for them. Some of the money that hasn’t been spent is going to have to be paid because of NICE guidelines and all the rest of it.’
As for strategic planning, Dr Dixon adds: ‘It is a question about how sophisticated the CCG is. Remember, the [Health and Social Care] Bill only went through a year ago. If you go back a year, many places didn’t know who their clinical leader was going to be.’
Perhaps most interesting about the conditions in general is that there has been an almost clean bill of health for CCGs in the area of GP engagement.
Only two CCGs have been given conditions of any kind in what the Board calls the clinical engagement domain, which includes getting practices to sign up to the constitution.
However, this might reflect the standard that the Board sets for this requirement. As Pulse has exclusively revealed, CCGs are not required to get signatures from all member practices; they only need to show practices have been engaged.
Dr Marshall says this is an area CCGs have improved in. He says: ‘We are aware that [good clinical engagement] has not always been the case across all CCGs. … It is encouraging that processes are improving.’
Jaimie Kaffash is a senior journalist at Pulse