Comment: Barometer shows where CCGs are heading

Not surprisingly, more than half of respondents felt that there would be a transfer of substantial clinical commissioning group responsibilities to a provider or groups of providers. We are already working with a number of health systems in developing lead provider and alliance contracts, and these are likely to remain the primary mechanism for transferring responsibility for achieving population-based outcomes to providers for the time being.

It’s perhaps understandable that NHS England has not prioritised what could be construed as a further top-down reorganisation

While respondents expressed an appetite for establishing “accountable care organisation” or “accountable care system” type arrangements, more work is needed to understand how budgets could be transferred from commissioners to providers, and what the residual functions of CCGs would be, in order to realise this ambition.

Nearly 60 per cent of respondents would like NHS England to lift what is described as an informal ban on CCGs merging. Many groups have already established shared management teams or other collaborative arrangements enabling them to benefit from economies of scale and coordinate their commissioning activities across larger geographies.

Given that this can be achieved within the existing statutory and organisational framework, it’s perhaps understandable that NHS England has not prioritised what could be construed as a further top-down reorganisation of the health system.

The anticipated shift in commissioning functions from NHS England to local CCGs is also reflected in the barometer, with nearly 90 per cent of respondents expecting responsibility for commissioning both primary medical services and some specialised services to move to CCGs by April 2017.

While the arrangements for delegating primary medical services commissioning responsibilities are now well established, further work will be needed to set up a model for delegating specialised commissioning functions that can be applied consistently across the country.

Peter Edwards is senior partner at Capsticks