Future autonomy of CCGs in doubt, says specialised care expert

The director of the Specialised Healthcare Alliance says CCGs autonomy may be ‘muted' by the proposed commissioning support arrangements.

John Murray, director of the Specialised Healthcare Alliance, a coalition of 68 patient organisations said: ‘I'm a bit sceptical about the CCGs and the extent to which they'll have a genuinely local identity which they can then exercise. The management which allows those groups is going to be crucially important and so far it seems to me that it's been set at a level at which will thrust the CCG into the arms of the cluster arrangement which I'm sure will continue in some shape or form. My question has always been which will be the tail and which will be the dog? And which will be wagging which?

‘I have a sneaky suspicion that except for the very largest commissioning groups cluster arrangements, commissioning support arrangements if you like, will be hugely influential in terms of what CCGs do and their autonomy will thereby be somewhat muted despite the bill's duty for the board to encourage autonomy throughout the system.'

Speaking at the same Westminster Health Forum on the subject of the NHS Commissioning Board in London earlier this week, Dr Judith Smith of the Nuffield Trust said the localised and devolved approach of the reforms meant relations between the NHSCB and CCGs would be different in different areas.

Dr Smith, head of policy at the Nuffield Trust, said: ‘That will be because of the experience, the stage of development of the clinical commissioners and the personality in the sense of what has been the PCT.

She added: ‘A concern I have at a time of constrained management costs, is that we know that organisational development training tends to come under pressure and there isn't much money for management support.

‘I guess I would be making a plea that the board, clusters, outposts whatever will play a role in setting risk, authorisation – those are very parental roles – but also about the nurturing side, the helping but also taking action when it's not working right where people are like the dog with the piece of cloth and tussling [to control it].'

Earlier this week the new Clinical Commissioning Coalition, set up by the NHS Alliance and NAPC, demanded a new relationship with the NHSCB with clinical commissioners represented at every level, including every panel authorising CCGs.