Section 4: Clinical commissioning groups

This section sets out background information on CCGs clinical commissioning groups and is for information only.

Auditors are not required to undertake any work on CCGs clinical commissioning groups in 2012/13. However, auditors of NHS trusts and PCTs primary care trusts may find the information set out in this section helpful in planning and undertaking their local VFM value for money work in 2012/13.

The Commission issued APB Audit Policy Briefing (issued by the Audit Commission) 09-2012 in August 2012, setting out the changes to the NHS introduced by the Health and Social Care Act 2012. APB Audit Policy Briefing (issued by the Audit Commission) 03-2013, issued in February 2013, updated auditors on the issues included in APB Audit Policy Briefing (issued by the Audit Commission) 09-2012, particularly around the abolition of PCTs primary care trusts and SHAs strategic health authorities and the transition to CCGs clinical commissioning groups, and included new or emerging issues that are relevant for all NHS bodies. Auditors may wish to refer to these APBs for a comprehensive picture of the changes.

Background

The 2012 Health Act Health and Social Care Act 2012 makes CCGs clinical commissioning groups directly responsible for commissioning most healthcare services, including: urgent and emergency care; elective hospital care; community health services; maternity and newborn services; children's healthcare services; mental health services; and NHS continuing healthcare.

CCGs clinical commissioning groups will:

• comprise two or more GP general practitioner practices;

• have boundaries that should not normally cross those of local authorities;

• be responsible for their whole population, not just registered patients; and

• be supported by clinical networks (advising on single areas of care) and new ‘clinical senates’ in each area (providing advice on local commissioning plans) – both hosted by NHS England (known until 1 April 2013 as the NHS CB Commissioning Board).

Establishment of CCGs

Groups of GPs general practitioners and GP general practitioner surgeries began to form during 2010/11 in preparation for formal establishment and authorisation. The NHS CB Commissioning Board authorised all 211 CCGs clinical commissioning groups in four waves between December 2012 and March 2013. Of the 211:

• 43 were fully authorised to take on their functions from 1 April 2013;

• 153 were authorised with conditions; and

• 15 were authorised with conditions that required higher level support, underpinned by legal directions.

On 22 March 2013 the NHS CB Commissioning Board Authorisation Sub-Committee reviewed the progress made by the 130 CCGs that were authorised with conditions in the first three waves. As a result:

• 63 CCGs clinical commissioning groups with conditions set at authorisation had formally discharged all of the conditions;

• 47 of those with conditions and formally discharged some of the conditions; and

• two had their legal directions lifted.

Of the remaining CCGs clinical commissioning groups, more than half have fewer than five conditions remaining. However, in some cases, the support level has been increased for some of the outstanding conditions.

No CCG clinical commissioning group will take on its full statutory functions before 1 April 2013. PCTs primary care trusts will retain overall responsibility for commissioning of local healthcare, and accounting for resources used, for 2012/13.

Duties of CCGs

CCGs clinical commissioning groups and NHS England will be subject to some duties that did not previously apply to PCTs primary care trusts or SHAs strategic health authorities. These include new duties to:

• promote the NHS Constitution;

• secure continuous improvements in the quality of services commissioned;

• reduce inequalities;

• enable choice and promote patient involvement;

• promote integration; and

• promote innovation and research.

CCGs clinical commissioning groups must:

• publish an annual commissioning plan;

• consult with Health and Wellbeing boards in assessing local needs and developing commissioning plans to meet them;

• publish an annual report;

• achieve financial balance year-on-year;

• reduce inequalities; and

• promote patient involvement.

To deliver these requirements, CCGs have been given 2.3 per cent more funding than their equivalent share of PCT funding in 2012/13. However, there will be an urgent review of the funding formula before 2014/15 allocations are announced, to allow more funding to be allocated to those areas with the greatest health inequalities.

Commissioning support units

CSUs commissioning support units have been set up to provide support to CCGs clinical commissioning groups. In 2012/13, CSUs commissioning support units will be hosted by PCTs primary care trusts and are relevant to the audit of the PCT primary care trust. There is no prescribed model for commissioning support. At 1 April 2013 there were 19 CSUs commissioning support units. These are hosted by NHS England, although their staff are employed by the NHS Business Services Agency. CSUs commissioning support units are not legal bodies in their own right, but they will be supported by NHS England as they continue to develop.