Leader: CCGs given the robustness to lead

You would forgive the leadership of clinical commissioning groups for feeling a little overawed by the size of the task in front of them, especially in the face of increasing system pressures. But the latest HSJ barometer survey of CCG leaders shows they remain relatively bullish in their belief they can drive up quality and stay within budget.

‘CCGs continue to be the statute upon which the big pigeon of helpfulness that is NHS England sits’

CCG leaders acknowledge weakness in areas such as public engagement and, especially, “information or measurement”. However they give themselves top marks for “leadership” and there is some hope this is not simply hubris.

Asked how much contribution individuals or groups made to CCG leadership, the respondents revealed an encouraging picture.

The contribution of the most senior GP was ranked alongside that of the most senior manager. There was a similar balance of contribution between other GPs sitting on CCG governing bodies and the wider management leadership.

Making a contribution

It is a good sign that in more than two-thirds of CCGs GPs not sitting on the governing board are making a contribution. But this commitment cannot consistently be relied on. Jobbing GPs are busy and will get busier. If − as the health secretary appears to want − the variability in primary care is finally to be addressed, the increased scrutiny is also likely to have them concentrating on the day job.

It is the efforts of those which occupy formal positions on CCGs that will give the groups a sustainable future and, for all the “clinically led” commissioning rhetoric, CCGs will prosper if they engage and exploit the talents of both managers and clinicians willing to commit to system leadership.

This is the scenario which held true in the early days of primary care trusts, before the command and control culture degraded clinical engagement.

This is why it is essential NHS England is successful in treading a careful line between oversight and control.

‘The tussle for the wheel need not be a negative. The NHS tends to suffer through a deficit, not a surfeit, of leadership’

The respondent who declared: “CCGs continue to be the statute upon which the big pigeon of helpfulness that is NHS England sits,” clearly thinks there is work to be done. But nearly 70 per cent of CCGs claim to have a “good” or “very good” relationship with their local area team - a score which would not have happened in the days of strategic health authorities and PCTs. CCGs also appear to be more or less neutral in their view of NHS England’s national team - which again is an improvement on how PCTs saw the Department of Health.

Ready for the challenge

There appears to be good evidence the significant involvement of GPs in CCG leadership − as well as their partnership with managerial colleagues − has given commissioning groups a robustness which − for understandable reasons − PCTs lacked.

CCGs, for example, are very clear they should lead, either separately or together across health economies, on “major service change”. NHS England, in most cases, is viewed as a junior partner.

This appetite for leadership will be tested by NHS England’s logical desire to use its specialised commissioning muscle to achieve greater consistency across the country and the ambitions of providers - which in many cases have as a good an understanding of the challenges ahead as CCGs.

But this tussle for the wheel need not be a negative. The NHS tends to suffer through a deficit, not a surfeit, of leadership. If respectful and well considered debates can determine which organisations − or groups of organisations − can lead in each situation then the NHS will move forward.

There will not be the certainty of the past system − and that will be frustrating when the blindingly obvious cannot be made to happen rapidly. Instead it will be up to CCGs to prove that local decisions are more sustainable. They appear up for that challenge.