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CCGs are failing to involve GPs in commissioning decisions, finds NAO



CCGs are not able to effectively include GPs in commissioning decision making, Government auditors have warned.

National Audit Office (NAO) report, published yesterday, listed a range of ‘barriers’ that were ‘inhibiting effective clinical involvement in CCGs’.

These included problems with ‘engaging’ with local GPs and too many decisions being made at a national level, at short notice.

The NAO report said CCGs face a lack of autonomy with frequent ‘central requests to implement new initiatives’ giving them ‘little time to develop coherent strategies and consult with GPs’.

It also warned that ‘reduced running cost allocations and additional responsibilities’ were ‘making it difficult for CCGs to develop a high-quality clinically led commissioning function’, whilst there is ‘a lack of support from NHS England for making tough decisions about prioritising services’.

According to the NAO, CCG challenges include ‘engaging with all GPs in a local area’ and ‘developing the next generation of GP leaders’. 

Other challenges include ‘maximising the contribution of CCGs’ GP leaders’ and issues with conflict of interest management, the report suggested.

Rating CCGs’ overall performance, the NAO said over half were ‘good’ or ‘outstanding’, although 42% (87 of 207) were either classed as ‘requires improvement’ or ‘inadequate’, with 24 deemed to be failing, or at risk of failing.

Problems with budget overspending were rife, with 36% of CCGs spending more than planned in 2017/18 – a total overspend of £213m across all CCGs.

However – despite CCG flaws – the NAO concluded with a warning to advoid any new ‘major organisational restructuring’ to commissioning, as this has the potential to cause ‘significant upheaval’.

It said: ‘Following almost three decades of change, NHS commissioning needs a prolonged period of organisational stability. This would allow organisations to focus on transforming and integrating health and care services rather than on reorganising themselves.’

Julie Wood, chief executive of NHS Clinical Commissioners, said: ‘Although there is a mixed picture, [this] report highlights the good work that is happening in many parts of the country to deliver positive health outcomes, especially in these challenging financial times.’