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How clinical commissioning groups operate and their main responsibilities

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This section explains how clinical commissioning groups (CCGs) operate and their main responsibilities. We recommend you read this section before moving onto the 'Engaging with your CCG' page.

What are CCGs responsible for?

CCGs are responsible for commissioning the majority of services around health in England, including hospital care, community health services, rehabilitation services, mental health services and others. NHS England has responsibility for commissioning in certain areas, including specialised services, core GP services, and dental, pharmacy and optical services (although a new policy initiative referred to as ‘co-commissioning’ gives the option to transfer responsibility for commissioning GP services to willing CCGs).

CCGs have a number of duties which they must take into account when exercising their functions. These include duties to improve services, reduce inequalities, promote patient involvement, provide patient choice, promote innovation and promote the integration of health services. Importantly, CCGs also have a duty to consult patients and the public at various specified stages of the commissioning process, including when creating commissioning plans, developing and considering proposals for change and making decisions affecting the operation of commissioning.

NHS England’s comprehensive summary of CCG functions provides further detail, including on their specific legal duties. Transforming participation in health and care guidance also sets out how CCGs should involve patients, carers and the public in their decision making processes.

What areas do CCGs cover?

CCGs do not align with local authority boundaries; it is likely that there will be several CCGs within each local authority, and indeed some that cross county boundaries. Typically, CCGs will cover between 150,000 and 300,000 patients each, but some larger CCGs cover a population of over half a million. There are currently 211 CCGs in England. You can locate your local CCG on the NHS Choices website.

Structure of CCGs

CCGs have a significant degree of control over their governance arrangements so there is local variation. This section summarises common features. 

  • Governing body: CCGs are required to have a governing body which is responsible for the CCG’s key decisions. The governing body is chaired by an elected GP, and includes representatives from other GP members, members of the executive team, a hospital doctor, a nurse, lay members and representatives from other local partners. Some members will concentrate on a specific area of the CCG’s work – in particular, one of the lay members will have specific responsibility for patient and public participation. Lay members may be drawn from the voluntary sector. A proportion of the governing body’s work is likely to be delegated to sub-committees.
  • Members and member council: all GP surgeries are required to be members of a CCG. Most CCGs will have a member council; the exact function of these varies, but they generally represent the membership and liaise with the governing body and executive team. Member councils may also agree the vision and values of the CCG, approve the commissioning plans and any changes to the constitution.
  • Locality structures: Most CCGs, especially larger ones, will have locality structures for geographical areas within the CCG boundary. This is the system that allows the CCG to operate as a true membership organisation, and builds upon the engagement with each individual practice. Locality structures will co-ordinate a group of practices within their area and will report back to the CCG governing body. In some areas, localities may have a significant degree of autonomy: and some may be allocated a commissioning budget and flexibility to keep any surplus to re-invest in locally.
  • Executive team: The executive team manages the day to day activities of the CCG. The size of the team will vary according to which activities have been outsourced and which have been kept within the CCG.

How clinical commissioning groups fit into the health commissioning landscape

CCGs and commissioning support units

CCGs are generally much smaller than their predecessors primary care trusts (PCTs), and therefore many need to outsource support services. The biggest providers of such support are Commissioning Support Units (CSUs). Most CSUs have retained some of the personnel and experience from PCTs and offer local and practical commissioning support such as procurement, contract management, business intelligence, service redesign, communications and public and patient engagement, the latter being particularly relevant to the voluntary sector.

There are a number of CSUs across England registered on the "Lead Provider Framework" (organisations which have qualified to deliver support services). CCGs are free to contract with whichever CSU they wish, choose another provider or retain services in house. Engaging with the CSU as well as CCG can expand the opportunities that voluntary organisations have for involvement in the commissioning process. 

If you are representing a local voluntary sector organisation, it is worth finding out how the CCG in your area works with CSUs or other support services to help determine who best to engage with. Contact your local Regional Voices' network to find out about voluntary sector engagement opportunities with CSUs.

CCGs and NHS England

NHS England wears a number of different hats. It holds CCGs to account and draws up an annual performance assessment of each CCG. It also supports CCGs in improving health outcomes for people in England by providing support on areas such as commissioning, partnerships and relationships, and quality improvement and clinical leadership. Lastly, NHS England also commissions specialised services, primary care services, armed forces health and health in justice. It either commissions services directly or works with CCGs as a collaborative commissioner (co-commissioning).

NHS England aims to engage patients and the public in all its commissioning and there are many opportunities for the voluntary sector to engage with NHS England, including through NHS Citizen, lay membership of clinical reference groups and by working with Health and Care Voluntary Sector Strategic Partners.

CCGs and health and wellbeing boards

CCG representatives are statutory members of health and wellbeing boards (HWB). The HWB is responsible for producing the joint strategic needs assessment and the joint health and wellbeing strategy, which CCGs must take into account when producing their commissioning plans. The local HWB must also be consulted by NHS England when it is drawing up its report on the annual performance of each CCG.

CCGs….and CCGs

CCGs, particularly those which cover smaller numbers of patients, often collaborate with each other. For instance, in some areas, one CCG will be designated as a lead commissioner to minimise the procurement burden and co-ordinate the management of providers; in other areas, CCGs will share senior executive posts or enter into schemes to share financial risk. At the very least, it is likely that neighbouring CCGs will have put in place arrangements to keep each other informed of their activities.

5 step guide to engaging with your CCG

Page last edited Mar 28, 2017

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