Understanding primary care co-commissioning: Uptake, scope of activity and process of change

The Policy Research Unit in Commissioning and the Health Care System (PRUComm) was commissioned by the Department of Health to study the development of Clinical Commissioning Groups (CCGs). We have been following CCGs’ development since their initial establishment as ‘Pathfinders’ (the programme was announced in October 2010 and the first Pathfinders were established in January 2011).
In the first phase of the project (January 2011 to September 2012), we followed the development of CCGs (initially known as GP Commissioning Consortia) from birth to authorisation i.e. from when they were involved in the ‘pathfinder’ programme and were officially sub-committees of their local PCT Cluster until their authorisation in April 2013. We conducted an intensive investigation working with eight case study sites alongside two national web-based surveys of CCGs. We explored issues that arose and were important as the CCGs developed and factors affecting their progress and development, as such we detailed the experiences of emerging CCGs being part of the ‘pathfinder’ programme (Department of Health, 2010a) and explored issues, which were drawn thematically from the evidence we found. This included the different approaches to being a membership organisation, how the emerging CCGs were developing their external relationships (for example with the Health and Wellbeing Board, other CCGs, etc.), and what approaches were being taken to commissioning and contracting (for full report see Checkland et al., 2012).
One of the issues highlighted by our participants in the first phase of the study was the perception of GP ‘added value’. Participants from many of our case study sites told us that they felt that the involvement of GPs had ‘added value’ in both commissioning and contracting. We followed up those claims in the second phase of our study (April 2013 to March 2015). For this phase, we started by interviewing both clinicians and managers in 7 case study sites to explore in more detail their understanding of the value of clinical input in commissioning (with concrete examples where possible). The findings from these interviews have been published (see Checkland et al., 2014; Perkins et al., 2014). The results from these interviews were used to focus on the next phase of data collection, in which the claims made were followed up in observations of the work of four of our existing case study sites (for full report see McDermott et al., 2015).
The focus of this report is on the third phase of the project (April 2015 to December 2017), which aims to explore the significant changes to the work of CCGs as they began to take over varying levels of new responsibility for commissioning primary care services from April 2015. The scope of activities includes general practice commissioning, local incentives scheme, general practice budget management, complaints management, and contractual general practice performance management (NHS England, 2014c).