Moving towards strategic commissioning: Impact on Clinical Commissioning Groups as membership organisations.

Objective
This paper aims to explore the nature of Clinical Commissioning Groups (CCGs) in England as membership organisations. Utilising the concept of meta-organisation as a lens, we discuss the impact that this organisational form might have on CCGs’ ability to become ‘strategic commissioners’.
Methods
We used a longitudinal qualitative approach to explore the adoption and implementation of primary care co-commissioning. The study was undertaken between May 2015 and June 2017, and included interviews with senior policy makers, analysis of policy documents, two telephone surveys, and case studies in four CCGs nationally.
Results
CCGs operate as membership organisations with closed boundary and low stratification, whereby a consensus or majority needs to be reached by members when activities impact on membership or the CCG’s constitution. While CCGs should move towards a more strategic commissioning role that is focused on local priorities agreed by their members they are faced with a complex system of accountabilities and responsibilities, which makes this difficult to achieve.
Conclusions
The nature of CCGs as membership-based meta-organisations has the potential to both help and hinder CCGs in becoming strategic commissioners. The complexities in accountability and governance that the membership approach introduces, and the potential difficulties that CCGs face with competing meta-organisations raises questions about the future of CCGs as membership organisations.