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Report from DH-funded body lays bare ‘lack of trust’ and handover tensions between CCGs and PCTs

GP commissioning leaders are increasingly frustrated with how the move to clinical commissioning is developing, with evidence emerging of managers withholding funds and refusing to co-operate with CCGs.

The unpublished research from six CCG areas found even enthusiastic CCGs were losing heart. Led by former Department of Health pathfinder lead Dr Paul Zollinger-Read, now medical director of BUPA, the report found the NHS reforms had been more difficult to implement than anticipated. It attributed this to an ‘unstable national set-up, the lack of appreciation of social and political complexities in the health sector, and unrealistic expectations about the capacity of GPs to lead such a major change’.

It said this was illustrated by tensions between CCGs and PCTs as well as GPs and secondary care providers. It said the reforms were fraught with uncertainty and a ‘lack of trust’.

The report said there was evidence that some PCT staff ‘felt threatened’ by CCGs, and some PCT members were ‘not always willing to openly co-operate with CCG leaders’. It pointed to issues such as PCT managers withholding funds for new arrangements because ‘nobody got the idea’.

The study said while ‘collaborative initiatives were common’ between clusters, communication from ministers was viewed as a ‘one-way process’, with GPs becoming disillusioned.

It concluded: ‘Throughout our study GPs felt increasingly frustrated with the policy process and the uncertainty around them. This is mainly due to isolation of politicians who are perceived to have a “pre-set agenda” which they are implementing without engaging. Also, we observed an increasing frustration among the CCGs. Several who were enthusiastic and motivated in the beginning started to believe their efforts are misplaced and they will not have the opportunity to innovate.’

The National Institute for Health Research study interviewed CCG leaders in 208 practices across the east of England and a 1.7 million population.

Dr Nigel Watson, chair of the GPC’s commissioning and service development subcommittee, urged the DH to ‘address the concerns’. A DH spokesperson said: ‘If this report is peer reviewed and validated, the DH will consider its findings. However, we are aware the picture may vary in different parts of the country.’


What the study found:

• ‘Significant variation’ among CCG leaders in managing relationships with PCTs
• Perception among CCG leaders that PCTs are being abolished for not succeeding
• PCT employees threatened by CCGs and aware of job insecurity, so not always willing to openly co-operate 
• Frontline GPs and CCG leaders becoming ‘increasingly cynical’
• GPs hesitant to engage because communication seen as a ‘one-way process’

Source: Clinical leadership and commissioning practice in healthcare innovation networks: An empirical analysis of CCGs in England