Fifteen clinical commissioning groups will be subject to close oversight and control by the NHS Commissioning Board as they take over budgets next month

The board this week announced all CCGs had been authorised, with the completion of its fourth wave of approval decisions.

The fourth wave of approvals saw the board issuing legal directions to seven CCGs. They give it specific powers over the groups – generally to approve their finance and service plans – and allow it to demand information from them.

 Number of CCGsAverage conditions per CCGCCGs with legal directionsNumber of legal directions
London324.649
Midlands and East616515
North682.424
South506.946

Those given directions in the most recent wave include Basildon and Brentwood CCG and Thurrock CCG, both in Essex.

Their directions cover the CCGs’ contract with Basildon and Thurrock University Hospitals Foundation Trust, which has been the subject of long running quality concerns. They dictate that the commissioning board will be able to “undertake any action it considers necessary, including ensuring cooperation with other regulatory bodies such as Monitor and the Care Quality Commission, in respect of ensuring that patient safety is maintained”.

GP practices in South Essex have been slow to agree on their CCGs’ shape and leadership. HSJ understands the board decided they had not settled basic requirements, and so could not be relied upon to oversee quality at their hospital provider.

As well as imposing legal directions, the board ordered two Essex practices to join CCGs, after they refused to sign up of their own accord. One was ordered to join Basildon and Brentwood CCG and one Thurrock CCG.

The other commissioning groups issued with legal directions in wave four are: Enfield CCG and Croydon CCG, both of which are likely to face financial problems; Waltham Forest CCG; East Surrey CCG; and High Weald Lewes Havens CCG.

Of all England’s 211 CCGs, 15 have legal directions.

HSJ understands the commissioning board is due to issue an interim CCG assurance framework – which will set out how its local teams should performance manage the groups – in the near future.

A long term assurance framework will be drawn up in discussion with CCGs later in the year.

The interim framework is expected to say successful CCGs – those without or with very few conditions on their authorisation – should be free of close monitoring and management by the local teams.

Those with legal directions or with lots of conditions will be subject to closer attention.

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