'An exploration of how Clinical Commissioning Groups (CCGs) are tackling health inequalities in England'

    Student thesis: Phd


    This research aimed to explore how newly forming Clinical Commissioning Groups (CCGs) were tackling health inequalities (HIs) (if at all) in the UK. In 2010 the current coalition government was formed between the Conservatives and Liberal Democrats. Shortly after this, the White Paper Equity and Excellence: Liberating the NHS (Department of Health, 2010a) was published. This was the starting point for a large variety of policy documents being published outlining the healthcare changes that were to happen within the UK. Following the 'pause' a number of amendments to the initial policy proposals were outlined (Department of Health 2011). These included the newly named GPCCs being restructured and renamed as CCGs. Additionally, the Government took on board the recommendations of the Future Forum (June 2011) to make tackling HIs a duty for CCGs. The concept of HIs itself is very complex with a wide variety of definitions that have been discussed within the literature. It was acknowledged early on within this project that because of the complexities and variations in people's understandings and interpretations of HIs that a fundamental element of understanding how CCGs are tackling health inequalities would be underpinned by individual's own and organisational conceptualisations of HIs. Three CCGs in the North of England were recruited and qualitative methods, including interviews, observations and document analysis were used to collect data, over a period of 12 months from January 2012-December 2012. The timing of the project meant that data collection was conducted when the NHS was in a state of flux; CCGs were in shadow form, preparing themselves for the authorisation process. Interviews and observations ascertained that HIs were being conceptualised and tackled differently across the three CCGs. There were several common themes that were evidentially important to CCG members when describing the wider influences on their HI understandings and strategies to tackle HIs. These included history, relationships and the role of Public Health. The history of both organisations and relationships were acknowledged by all CCGs in shaping how they had developed under the current policy agenda and how they planned to tackle HIs (if at all). The role of Public Health was a key finding from this research, three different roles were identified, defined and explored in practice, examining how the roles influenced the HIs agenda differently. The Public Health roles of 'service provider', 'co-owner' and 'critical friend' have the potential to shape working relationships between Public Health and the CCG and shape the HIs agenda. Weick's (1995) concept of sensemaking was used to examine how these main findings helped define the HIs agenda. Overall, HIs conceptualisation, strategies to tackle HIs and wider organisational relationships with PH and the LA are not consciously developed by these organisations. History and local contexts help generate schemata that underpin action.
    Date of Award31 Dec 2014
    Original languageEnglish
    Awarding Institution
    • The University of Manchester
    SupervisorKatherine Checkland (Supervisor), Stephen Harrison (Supervisor) & Anna Coleman (Supervisor)


    • Clinical Commissioning Groups
    • Health Inequalities
    • Health Policy

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