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GP Commissioning: dispatches from the frontline

I was somewhat surprised when the Chair of our developing CCG sent me a copy of a letter she recently received from the newly formed SHA cluster. As a first wave pathfinder we have progressed well so far on our journey to potential authorisation.  As a result of this progress we had ‘green rated’ ourselves in the very early self assessment which all pathfinder CCGs were recently asked to submit for SHA review.


To date, all of our member practices have a seat on our developing board. We have a vibrant clinical working group which has already begun to realign community nursing services with constituent practices, has decommissioned an unsuccessful service for patients with mild to moderate mental health problems and gone through a procurement exercise to appoint a new provider for these patients from a different region.  We are also showing around a 3% underspend against our indicative budget. 

We have enthusiasm and spirit. 

However the SHA review deemed us as a ‘red rated’ CCG based almost singularly on our geographic fit rather than considering our affinity or achievements to date; hence my surprise in receiving a letter advising that the SHA did not consider us meeting current expected standards and that we should consider changing our configuration – to be part of ‘an effective CCG’.

With the agreement with our member practices, our Chair has written to decline this offer and advise the SHA that we plan to continue on our pathfinder progress, in the full recognition that there will be a range of risks to assess; and it is whether we can mitigate against these that will lead us to a decision about future viability, configuration and the commissioning support that we need.   

If clinicians are really going to take ownership of the reform agenda, I think it important that CCGs do not always wait for permission to develop services for our patients.

Dr James Kingsland is senior partner at the St Hilary Brow Group Practice, Wallasey, Merseyside, National Clinical Lead, NHS Clinical Commissioning Community, and president of the NAPC