Underperforming CCGs must improve, says PAC

The Public Accounts Committee has released its report into Clinical Commissioning Groups, and is concerned about the impact on patient outcomes if the performance of Clinical Commissioning Groups (CCGs) does not improve.

In 2017-18, 42 per cent of CCGs were rated either 'requires improvement' or inadequate'.

Calling for "robust accountability structures which make it clear who is ultimately responsible for planning and commissioning decisions," the PAC report summary states:

"The NHS Long Term Plan sets out the intention for Integrated Care Systems to cover the whole of England by 2021. This will result in a significant reduction in the number of Clinical Commissioning Groups (CCGs).

"The changes in organisational structures since 2012 have been particularly confusing and rapid. The changes make it challenging for taxpayers to understand who in their local area is accountable for health spending and performance.

"It is important not to lose sight of the need for robust accountability structures which make it clear who is ultimately responsible for planning and commissioning decisions and to make this transparent to the public. The alphabet soup of health bodies that has grown up has done so, in many instances, without clear governance and accountability.

"Many CCGs are currently underperforming and this will need to improve as they take on the responsibility for commissioning services across larger populations.

"Getting the commissioning structures right will be an important part of delivering the NHS Long Term Plan. This will need to include: establishing appropriate structures for Integrated Care Systems and CCGs; ensuring CCGs take account of the needs of local populations as commissioning is undertaken at a larger scale; having clear accountability structures in place as planning and commissioning decisions are made jointly across the organisations within Integrated Care Systems; and ensuring legislative changes support the delivery of the NHS Long Term Plan.

"At the same time the public need to know how these changes will benefit healthcare and health outcomes in their area."

In its conclusion and recommendations, the PC report states:

"When reporting back to us at the end of 2019, NHS England should provide an update on what it expects the structure of NHS commissioning to be by 2021. This should include: how local circumstances are being taken into account as it determines the structure of CCGs and Integrated Care Systems; an update on the expected number of CCGs; the number and configuration of Integrated Care Systems; and an estimate of the redundancy costs CCGs will incur."