Exploring the GP ‘added value’ in commissioning: What works, in what circumstances, and how?

One of the main focusses of the Health and Social Care Act 2012 (implemented from 2013) was on the development of Clinical Commissioning Groups (CCGs) to replace Primary Care Trusts (PCTs) in commissioning healthcare for their local populations. These organisations were designed to unleash the potential of involving a broad range of clinicians in commissioning of healthcare. Groups of GPs wishing to form a CCG (initially known as GP Commissioning Consortia, GPCC) could put themselves forward to be ‘Pathfinders’, charged with testing different design concepts and identifying areas of learning to inform the overall programme. GPCC would need to demonstrate their capability to take over commissioning to the NHS England (previously known as NHS Commissioning Board) in order to be ‘authorised’.This report presents the findings from a second phase of our ongoing study following the development of CCGs in England since 2011. In the first phase of this study (January 2011 to September 2012), we followed the development of CCGs from birth to authorisation i.e. from their involvement in the ‘pathfinder’ programme and officially becoming sub-committees of their local PCT Cluster until their authorisation in April 2013. One of the issues highlighted by our participants in the first phase of the study was the perception of GP ‘added value’. During the authorisation process, NHS England set out what they believed clinicians would add to commissioning. Domain 1 (out of 6) of the authorisation process focused on clinical added value, requiring CCGs to show “a strong clinical and multi-professional focus which brings real added value” (NHS Commissioning Board, October 2012:11). This added value was said to include: strengthened knowledge of the needs of individual and local communities; increased capability to lead clinical redesign and engage other clinicians; and greater focus on improving quality of primary medical care. NHS England has sets out further what an “excellent practice” looks like across a range of areas central to commissioning in the Draft Framework of Excellence in Clinical Commissioning (NHS England, November 2013).The aim of the second phase of our study was therefore to follow up those claims made in the first phase around issues of GP ‘added value’. We explored further the potential added value that clinicians, specifically GPs, bring to the commissioning process in interviews, and followed this up with observations of commissioners at work.