Strategic Health Authority (SHA) risk assessments forced many clinical commissioning groups (CCGs) mergers that were "initially unwelcome".
A Department of Health-funded report into the early development of CCGs shows the mergers “hindered” the organisation’s development.
The national political context has also affected the development of CCGs.
The research shows many CCG leaders do not want to be seen either as ‘supporters’ or ‘opponents’ of the national policy but see themselves as “working to improve care for patients regardless of the national policy situation in which they are operating”.
“There is widespread support for the idea of greater clinical involvement in commissioning,” said the report.
“However, many believe that this could have been achieved without the need for the current national reorganisation.”
The report also claims CCGs have been set up to “mirror” primary care trusts (PCTs) and practice based commissioning (PBC) groups and that the influence of the NHS’ past history was “much in evidence”.
t is suggested this could be because “most” of those GPs taking up leadership positions have acted as leaders in the past in other organisations such as PCTs or PBC groups.
Despite this, it is claimed there has been a “great deal” of enthusiasm from leading GPs as they engage with the new structures.
“Overall, we found evidence of a great deal of activity and hard work on the ground by those involved with the development of CCGs. governing body GPs and local managers are working together with a great deal of energy and commitment to implement the changes,” said the report.
At the time of the research carried out by Policy Research Unit in Commissioning and the Healthcare System (PRUComm), developing CCG structures were said to be “complicated and multi-layered”, as developing CCGs worked out how relationships between governance structures, operational responsibilities and grassroots’ members would work in the longer term.
The report warned it “remained unclear” how CCGs in the case study sites will address the need to be accountable both upwards to the NHS Commissioning Board (NHS CB) and downwards to their members and to the public at large.
A potential tension between a CCG’s desire to be a meaningful membership organisation and the perceived need to manage performance was also identified by researchers, after the CCGs studied and survey respondents reported they regarded the performance management of practice behaviour relating to commissioning – such as referrals and prescribing – as a “legitimate role for CCGs”.
The study involved detailed qualitative case studies in eight developing CCGs across England from Sept 2011-June 2012, as well as conducting web surveys of all developing CCGs at two points in time – December and April.