Kent health services expert contributes to report on new clinical commissioning groups

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The University’s Professor Stephen Peckham is one of the authors of a new report that has concluded that Clinical Commissioning Groups (CCGs) – the new family doctor-led bodies responsible for commissioning the largest chunk of healthcare in England – are accountable to too many masters.

Professor Peckham is Director of the national Policy Research Unit in Commissioning and the Healthcare System, which undertook research, published in the online journal BMJ Open on 13 December, and found that CCGs have potentially competing agendas.

CCGs are membership bodies that were introduced in April this year as part of a major restructuring of health and social care services in England. They replaced primary care trusts (PCTs). The aim of the restructuring was to boost the accountability of those responsible for commissioning care for patients while at the same time giving them greater autonomy than that enjoyed by their predecessor organisations.

The researchers, led by the University of Manchester, studied the developing accountability relationships of eight CCGs. Between September 2011 and June 2012, they interviewed 91 people, including family doctors (GPs), managers, and governing body members; carried out 439 hours of observation in many different types of meetings; and analysed a wide range of documents.

CCGs are externally accountable to NHS England (the government); Monitor (the regulator), Health and Wellbeing Boards (public health and social care); the local Health Watch (patients); the public; local medical committees (GP bodies); and the local authority Overview and Scrutiny Committee (public health). They are also internally accountable to the CCG governing body, member practices and locality groups.

However, the report points out that the accountability relationship with NHS England is the only one that is clearly defined and where sanctions apply.

Professor Peckham, who is Director of the University’s Centre for Health Services Studies, said: ‘We concluded that CCGs are indeed more accountable than PCTs. In fact, they “are at the centre of complex web of accountability relationships, both internal and external”.

‘However, whether this translates into being more responsive, or more easily held to account, remains to be seen.’

Dr Kath Checkland, from the Centre for Primary Care at the University of Manchester, who led the research, said: ‘This early study raises some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing, or conflicting, agendas, and the lack of clarity over the operation of sanction regimes.’

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