Commissioning, System design

NHS Commissioning Board must ‘walk the walk’ when it comes to local autonomy says Michael Dixon

Michael Dixon

In fewer than 100 working days, clinical commissioning groups (CCGs) will take up their full responsibilities.  The pain of authorisation will largely be over, the new commissioning architecture of the NHS in England mainly in place, and the key frameworks and tools for measurement mostly understood.


CCGs are ready to take up their responsibilities, are determined to deliver better outcomes for their patients and are single-minded about driving out health inequalities in their populations. They aspire to be the best and look forward to working with the NHS Commissioning Board (NHSCB) to ensure that all parts of the commissioning system are supporting their goals.


So NHS Clinical Commissioners (NHSCC), the independent collective voice of clinical commissioning groups, has announced that, to support the NHS Commissioning Board, we will be developing a local-led assessment of the board


Speaking at last week’s NHSCB board meeting, NHS medical director Bruce Keogh said that appraisal should never be an add on, a sentiment I welcome and endorse. I totally believe that working with practices, patients and stakeholders from across health and social care, NHSCC and the CCGs are best placed to gather the intelligence needed to hold a mirror up to the new system.


The National Commissioning Board will have a role ensuring that CCGs are delivering the outcomes for patients required through the Commissioning Outcomes Framework.  Equally, we recognise that CCGs have a central role to play in assisting the NHSCB to understand how they and their local offices are supporting the work of CCGs. It is also essential that feedback is provided to the Board on its performance as commissioner of specialised services and primary care.


The Health and Social care Act has fundamentally changed the balance of power between the centre and local organisations. The existence of the CCG-led appraisal is itself symbolic of the changed relationship between CCGs and the National Commissioning Board.


So what should this new relationship look like? As I talk to colleagues in CCGs and more widely from across the system, I hear concerning rumours that while NHSCB staff may ‘talk the talk’ they are not yet ‘walking the walk’ when it comes to local autonomy. Particularly for staff in the local area teams, we need to see signs that they can ‘put their money where their mouth is’ and recognise that their role is to support and facilitate, not to performance manage CCGs.


We need to see a recognition that as clinicians we are working in a system which needs to provide a continuum of care. While it is welcome to see the Department of Health and the NHSCB promoting joint commissioning across CCGs and local authorities, we also see them need to recognise joint commissioning between the NHSCB and CCGs.


This is an exciting time to be a commissioner and a very different way of running the NHS.  Frontline clinicians and member practices should have confidence that their voice will be heard at the centre. CCGs will shine the light and the Board will be able to clearly demonstrate they are open to assessment and constructive criticism.


I firmly believe that working with the Board through a clear and transparent process, we will enable them to respond and develop actions that will continue to support and develop CCGs and clinical commissioners.

Michael Dixon is interim president of NHS Clinical Commissioners, the independent collective voice of clinical commissioning groups.

About NHSConfed .

The NHS Confederation is the membership body for the full range of organisations that commission and provide NHS services. We are the only body to bring together and speak on behalf of the whole NHS. We have offices in England, Wales (the Welsh NHS Confederation) and Northern Ireland (Northern Ireland Confederation for Health and Social Care) and provide a subscription service for NHS organisations in Scotland.


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