The changing NHS must hold on to the best of clinical commissioning

It seems like some parts of the health sector are all too ready to declare the end of clinical commissioning, particularly following the NHS long-term plan’s commitment to more “streamlined commissioning arrangements” and integrated care systems.

But while clinical commissioners will certainly have to work differently in the future – more strategically across larger footprints – they still have a valuable role to play to get the best health outcomes for their patients and the best value for each NHS pound.

In the six years since CCGs were established, the NHS landscape has changed significantly, and will continue to do so. But whatever the destination looks like, services will still need to be planned, prioritised, purchased, monitored and quality assured.

Clinical commissioning leaders have been moving towards a more strategic integrated commissioning function for some time, working collaboratively across health economies with their provider colleagues; we know from our members that there is a real appetite across the country to strengthen that strategic role at a geography larger than current CCG footprints.

However, one of the many strengths of clinical commissioning lies in the deep understanding of the demographics, needs and circumstances of the local population. As CCGs begin to work across larger systems, it is vital that this local insight and connection is not lost.

One of the many strengths of clinical commissioning lies in the deep understanding of the demographics, needs and circumstances of the local population

The newly-merged Leeds CCG, for example, benefits from economies of scale but are working at locality level to reduce unwarranted variation in the identification of people with certain health conditions.

Commissioning should reflect the needs of the population it serves – and as population health management comes to the fore, clinical commissioners already have considerable experience of using data to plan services in the local area.

Moreover, commissioners play an important role in bringing together different health and care organisations across a system, from trusts to local government, the voluntary sector and primary care, to join up services and work in collaboration towards common goals for the benefits of local populations.

When ICSs are covering the whole country, this role will be even more important.

Leading the way

CCGs are more than just convening organisations. Since they were established they have been leading the way with developing innovative approaches to healthcare, informed by patient and public involvement.

Collectively, they are responsible for almost two thirds of the NHS in England’s budget, and have a legal responsibility to spend it appropriately and effectively.

They say that necessity is the mother of invention, and this is perhaps nowhere more apparent than in the commissioning world. Against a challenging financial backdrop, clinical commissioners are working hard to make sure that the NHS’ finite resources are being used to gain best value.

In Blackpool, for example, the CCG has led the way with ensuring that procedures are only performed on those patients who will benefit from them.

Collective multidisciplinary collaborative leadership is the way forward as it will be more sustainable and will be more reflective of the NHS workforce challenge

They have also worked with provider colleagues to understand and redesign certain patient pathways, so that patients are seen in a more appropriate setting and in a more appropriate timescale, providing a better experience for the patient and ultimately saving money that can be reinvested elsewhere.

These decisions could not be made without either the clinical expertise or the local insight that clinical commissioners bring.    

This clinical leadership and expertise must not be lost as the system evolves; it must be amplified to be heard at all levels. CCGs have successfully established strong GP leadership; we must build on this to create a truly effective multiprofessional clinical leadership model.

Collective multidisciplinary collaborative leadership is the way forward as it will be more sustainable and will be more reflective of the NHS workforce challenge. Primary care networks can provide a vehicle to build this leadership model.

Crucially, they will remain linked to their local populations whilst also contributing to the leadership within ICSs. We must make sure that effective clinical leadership is embedded at neighbourhood, place and system level.

The long-term plan aims to support people to stay healthy, improve care for everyone, and deliver a sustainable and effective NHS. This is the core function of clinical commissioners, and without their unique skills and perspectives we risk losing a valuable piece of the puzzle that will help to make this ambition a reality.