The Nuffield Trust and The King's Fund argue that NHS England should review the way CCGs attract and develop board members, and must ensure that CCGs have adequate funding to fulfil their new role in primary care.
The report, called Risk or Reward?, is the second of a three-part study by the two organisations looking at the development of CCGs, and comes as many groups plan to take on co-commissioning of GP medical services.
Based on a survey of 279 GPs, observations, interviews and reviews of board papers, the analysis tracks six CCGs selected to broadly represent those across England, looking at their development as membership organisations and their role in developing primary care.
While CCG leaders and GP members surveyed were positive about the extended role in primary care, researchers found that the benefits of co-commissioning could be undermined by conflicts of interest within CCGs, constrained resources and strained relationships within CCGs and with NHS England in local areas.
Almost half (47%) of CCG leaders surveyed did not feel they had the time necessary to fulfill their existing role in the CCG, and CCG leaders interviewed as part of the fieldwork questioned whether they had sufficient capacity to expand into primary care commissioning.
Conflict of interest
While the majority of CCG leaders believed that conflicts of interest were being managed adequately, researchers highlighted examples of decisions where there was the potential for, or the perception of, a conflict having occurred.
The research also finds that there has been a significant drop in the numbers of GPs who reported being highly engaged in the work of their CCG, from 19% of respondents in 2013 to 12% in 2014. Within this, there was a 10% drop in the proportion of GP governing body members who reported being highly engaged.
Holly Holder, fellow in health policy at the Nuffield Trust and one of the report’s authors, said: ‘Our research shows that the future of the clinical role in commissioning healthcare remains fragile. While CCG leaders overall are still highly engaged in their work, our fieldwork and survey revealed this is waning and there are some worrying signs emerging over strained resources – both time and money.’
Ruth Robertson, fellow in health policy at The King’s Fund said: ‘CCGs are still relatively new organisations which need to be given time to develop and flourish. Our research shows that CCGs have the potential to play a really important role in driving improvement in the health service, but to do this they are going to need the right resources and support, along with the freedom and flexibility to develop local solutions.’