The Nuffield Trust's report Clinical commissioning: GPs in charge? culminates a four year research project conducted with The King’s Fund, which examined how GP attitudes towards clinical commissioning have evolved since their launch in the UK in 2013.
The report looks at what has been learnt in the last three years – including strategies to overcome challenges and identification of the main barriers to effective involvement – and makes recommendations for the future. Its findings about clinical involvement are relevant not only to policy-makers and CCGs but also to other organisations across the NHS involved in planning and designing services.
- Effective clinical involvement and clinical leadership are essential for high-quality commissioning.
- CCGs have achieved better GP engagement than previous forms of commissioning.
- CCGs have faced significant challenges in embedding clinical involvement in commissioning and have developed a range of strategies to overcome these. The challenges include: engaging with all GPs in a local area; developing the next generation of GP leaders; managing conflicts of interest and using links with GPs to improve the quality of general practice locally.
- CCGs identified three national barriers that are inhibiting effective clinical involvement: lack of autonomy to take decisions that meet local needs; budget and resource constraints; lack of support for tough prioritisation decisions
- There are clear steps NHS England and the Department of Health need to take to build on what CCGs have learnt, address the continuing barriers and embed clinical involvement in planning decisions across the NHS.
- NHS England must publish a vision for the future of NHS commissioning that recognises the overlapping planning and delivery structures that are developing in different ways across the country, and reaffirms the principle of clinicians being at the heart of planning decisions, wherever those decisions happen in the NHS.
- Commissioning needs to be promoted as a rewarding career option for clinicians and clinical leaders have access to the developmental support and training they need to do the job properly.
- Lessons should be learnt from the primary care co-commissioning process before transferring further commissioning responsibilities to CCGs.