Primary Care Co-Commissioning
In May 2014, CCGs were invited to come forward with expressions of interest to take on an increased role in the commissioning of GP services, which fall within NHS England's commissioning responsibilities. The intention was to give CCGs more influence over the wider NHS budget and enable local health commissioning arrangements that can deliver improved, integrated care for local people, in and out of hospital.
Co-commissioning is one of a series of changes set out in the NHS Five Year Forward View, and is seen as a key enabler in developing seamless, integrated out-of-hospital services based around the diverse needs of local populations. It provides CCGs with the option of having more control of the wider NHS budget, thus allowing for a shift in investment from acute to primary and community services.
Some of the potential benefits of co-commissioning include:
- Improved access to primary care and wider out-of-hospitals services with more services available closer to home;
- High quality out-of-hospital care;
- Improved health outcomes, equity of access, and reduced inequalities; and
- A better patient experience through more joined up services.
There are three types of co-commissioning models that CCGs are able to adopt:
- Full delegated responsibility for commissioning the majority of GP services;
- Joint commissioning responsibility with NHS England; and
- Greater involvement in GP commissioning decisions.
Whilst co-commissioning remains optional, it is clear that CCGs are being actively encouraged to embrace the opportunities that it can provide, and there has been a strong response to date. On 1 April 2015, 63 CCGs assumed full delegated responsibility for the commissioning of general practice services from NHS England and 86 CCGs entered into joint commissioning arrangements with NHS England.
Those with full delegated responsibility were required to enter into a delegation agreement with NHS England setting out the scope of the delegation in terms of areas such as budget control, disputes and claims.
Overcoming the challenges
Key challenges for CCGs in implementing co-commissioning include:
- Managing conflicts of interest arising from the CCG's increased role in commissioning and managing GP providers who are also members of the CCG;
- Performance management of individual GPs - CCGs are generally reluctant to manage the performance of their member practices, but arguably are best positioned to do so;
- Managing the expectations of their local GPs, where practices are keen to see the CCG involved and will be looking to the CCG to resolve fundamental problems; and
- Budget constraints - some CCGs have highlighted that delegated budgets have in effect been cut since the delegation has taken place and the CCGs may be left to make up any shortfall.