Identifying the opportunities for CCGs to make savings and efficiencies

One of the greatest challenges facing clinical commissioning groups as they take over responsibility for services is that they do not slip into replicating the commissioning patterns of the strategic health authorities and primary care trusts.

If they are to deliver the key aims of the Health and Social Care Act 2012, they will need to adopt a fresh approach to deliver improved outcomes while reducing the costs of bureaucracy.

In the current year, the CCGs are operating in shadow form but with a significant focus on delivering the 2012/13 quality, innovation, productivity and prevention plan. This highlights the importance of the CCG bringing on board the individual GP practices in order for savings to be achieved. For the CCGs to be efficient and cost-effective commissioning bodies they will need to focus on four key areas.

Economic and efficient procurement of services

GPs will have more power to commission services on behalf of their patients to promote better health and improve outcomes but the CCGs will need to as far as possible centralise the commissioning contract arrangements. Value for money will be the important test.

In some cases the CCGs will need to work across geographical boundaries and share resources, with collaborative arrangements with other CCGs. The commissioning support units will be there to help deliver the service, providing HR and IT support. This shared back-office support is essential for reducing costs and delivering efficiencies.

This process has been started with the clustering of the former 10 SHAs and 152 PCTs into four SHA clusters and 50 PCT clusters. CCGs now need to investigate the savings to be achieved from procurement support and outsourcing services.

Contract management and monitoring of health services

To secure the provision of secondary care at an affordable price, delivered in an efficient and effective manner, CCGs are going to need strong negotiating and monitoring teams from the outset to secure secondary care at competitive prices. The contracts will include an element of CQUIN (commissioning for quality and innovation) payments, resulting from secondary care providers achieving pre-agreed targets.

Appropriate monitoring should ensure that CQUIN payments are made only when the required target outcomes are achieved.

CCGs will need to look at setting up tight controls, using financial modelling to forecast income and costs.

Developing a robust governance structure

In the present preparatory year, CCGs must establish proper constitutional and governance arrangements with the capacity and capability to deliver all their varied responsibilities and duties.

The CCG must elect its governing board and once established, identify its vision, subsequent strategic objectives and principal risks and mitigating actions.

The CCG can then begin to ensure that it develops robust financial controls to support effective commissioning for all the services for which they are responsible.

CCGs are aware of the potential and apparent conflict of interest if there is not a clear delineation between GP commissioners and GP provider companies and it is important to avoid any future comeback on the CCG. To mitigate this risk, CCGs must ensure they develop comprehensive policies and protocols for members to follow.

Patient care pathways

There has already been significant work in the last couple of years on studying ways to improve integrated care and on managing patient care pathways, and this is seen as key in making the large savings required in the NHS. The CCGs now need to focus on delivering these collaborative arrangements between the local authority, the voluntary sector and the NHS.

Such collaborative working will require establishing policies and protocols and ensuring lines of communication are set up to engage with patients, their carers and communities. This effective partnership working is a new area and the CCG may need to look at their skills mix and ensure they either have or can procure the right one.

The collaborative arrangements for commissioning will undoubtedly evolve over the next few years as value for money and a critical review of patient outcomes become the means of judging the delivery of services to patients.

CCGs will need to ensure their financial systems are effective, that they not only comply with legislation but also adhere to policies and expectations, and that their governance stands up to rigorous tests.

This sets high standards and expectations for the CCGs in setting up their financial framework in the preparatory year.