Understanding Primary Care Co-Commissioning: Uptake, Development, and Impacts (Final Report)

The White Paper “Equity and Excellence” (Department of Health, 2010) and the Health and Social Care Act 2012 gave the power and responsibility for commissioning health services and budgets to groups of GP practices called Clinical Commissioning Groups (CCGs), previously named GP commissioning
consortia. The impetus for the Government’s reforms was to shift decision making as close as possible to individual patients. CCGs will commission the great majority of NHS services for their patients. However, they will not be directly responsible for commissioning services that GPs themselves provide. The responsibility for commissioning primary care services (medical, dental, eye health, and pharmacy) was given to a new statutory organisation called NHS England (NHSE), known as the NHS Commissioning Board in statute. This was to ensure a more standardised model and consistency in the management of the four groups.

However, it has become clear since 2010 that to properly match primary care provision to the needs of an aging population, local flexibility and understanding is required. There is considerable overlap between the ‘core’ General Medical Services (GMS) and Personal Medical Services (PMS) contracts (commissioned by NHSE) and services provided as ‘enhanced services’ (commissioned by CCGs), and it seems logical to bring those commissioning enhanced services into the process of commissioning the rest of primary care. Furthermore, the separation of funding streams between primary and community care means that CCGs lack the flexibility to shift funding to support patients most effectively at home.

This is the third phase of the project, which aims to understand the ways
in which CCGs are responding to their new primary care co-commissioning responsibilities from April 2015, providing feedback to NHSE supporting CCGs going through the approval process. The first phase of the project explored the development of ‘pathfinder’ CCGs, providing evidence to inform the process
by which CCGs moved towards authorisation (Checkland et al., 2012). The second phase of the project explored the ‘added value’ that GPs bring to the commissioning process, using a realist evaluation framework to provide some practical lessons for CCGs as they seek to maximise the value of the roles played by clinicians in their work (McDermott et al., 2015).