One year on, new commissioning groups are an improvement on their predecessors but do not reflect the views of members, say GPs

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Less than half of GPs feel decisions made by clinical commissioning groups (CCGs), the doctor-led bodies created by the NHS reforms to hold local health budgets, reflect their views, suggests a survey by the Nuffield Trust and The King’s Fund. However, the research also suggests that three times as many GPs think they can influence the work of their CCG than could influence their predecessors – primary care trusts. 

The research published today on the anniversary of the enactment of the NHS reforms, provides the top-line results from a survey of GPs in six CCG localities. Key findings include:

  • GPs have kept up their overall levels of involvement with CCGs compared to a similar survey carried out last year - 71 per cent feel at least somewhat engaged. But the proportion saying they are “highly engaged” fell from 19 per cent to 12 per cent, and GPs without a formal role in the CCG still feel much less engaged with their CCG than those with a formal role.
  • Less than four in ten GPs without a formal role thought decisions made by CCGs reflected the views of their membership, and just one in three felt the new groups were owned by their members. Meanwhile, only a minority of those GPs who did have a formal role thought they had enough support, time, and training to carry out their roles properly.
  • An increasing number of GPs agreed that CCGs have a legitimate role to play in influencing their clinical practice including prescribing, referrals and the quality of the care they provide to patients.
  • GPs were positive about how CCGs could change and improve general practice itself. Just over half felt that being part of a CCG had already improved their relations with other practices, and had changed the way they referred and prescribed. Although fewer felt that being part of the CCG had improved the overall quality of care they provide 
  • Respondents felt CCGs were much more likely to listen to them than the primary care trusts (PCTs) which held the same role before the reforms. 40 per cent said they could influence the work of the CCG, compared with only 13 per cent who had felt the same about PCTs.
  • GPs were more likely to rate CCGs as ‘very’ or ‘quite’ influential over their work (73 per cent) than any other body, including NHS England. Meanwhile, just 13 per cent felt that health and wellbeing boards, set up to oversee better joined-up care in the new system, were very or quite influential over their work at this stage.

Holly Holder, Fellow in Health Policy at the Nuffield Trust said: 'NHS leaders will be pleased to hear GPs say they increasingly accept the role of Clinical Commissioning Groups in helping to improve general practice, particularly when it comes to prescribing medicine, referring people to other services and the quality of care they provide to patients. The public face of NHS leadership might be Jeremy Hunt – or from today Simon Stevens – but GPs told us that CCGs did more to influence their work.

'Even so, concerns remain about CCGs’ ability to involve local GPs in their work. While overall engagement remains fairly similar to this time last year, only a third of GPs without a formal role reported that the CCG felt like ‘their organisation’ and a similar proportion said CCG decisions simply didn’t their views.

'With NHS England recently announcing plans to commission alongside CCGs, and Labour considering big power shifts to Health and Wellbeing Boards, it is clear that shape and role of commissioning groups will continue to change. NHS leaders should pause for thought at the fact that only a minority of CCG leaders told us they felt they had enough support, time and training to carry out the roles they have already been tasked with.'

Ruth Robertson, Fellow in Health Policy at The King’s Fund said: 'It’s encouraging to see that most GPs remain at least somewhat engaged with the work of their CCG – welcome news, given concerns  about GP work load pressures and low morale. However, there are signs that support from some initial enthusiasts has started to wane, as our data shows a drop in the number of GPs who are highly engaged in the work of the CCG. What makes CCGs new and different is the power they give clinicians to decide how local health services are run. Without close engagement from at least a core group of GPs, this key benefit they have over their predecessor PCTs will be lost. We will be paying close attention to engagement trends over the next year, as the sustainability of this commissioning model is dependent upon maintaining GP interest and enthusiasm during the tough times ahead.'

Notes to editors: 

  • This survey is an interim finding from ongoing work by The King's Fund and the Nuffield Trust to understand how the clinical commissioning groups at the heart of the NHS reforms are developing. Researchers are tracking six groups across the country in depth. The study began in September 2012, and will last for three years, with three annual reports. The first annual report was released in July last year: Clinical commissioning groups Supporting improvement in general practice? The next will be released in early September.
  • This online survey was circulated in January/February 2014 to GPs across six CCGs, which have been chosen to represent a wide range of different areas. Responses were received from 279 GPs and other practice staff. Results are compared to the previous wave of the survey, which was circulated in February/March 2013 and received 232 responses. 
  • The results of the survey are presented in an audio slideshow Clinical commissioning groups: One year on. The publication marks the anniversary of CCGs taking on full responsibility for most of the NHS budget on April 1, 2013.
  • The Nuffield Trust is an authoritative and independent source of evidence-based research and policy analysis for improving health care. Our vision is to provide objective research and analysis that boosts the quality of health policy and practice, and ultimately improves the health and health care of people in the UK.
  • The King’s Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.
  •  For further information, or to request an interview, please contact the Mark Dayan in the Nuffield Trust press office at mark.dayan@nuffieldtrust.org.uk, 020 7462 0538, or on 07779 227 129 out-of-hours.

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