Powerful ‘incentives, rewards and sanctions’ should be established to drive CCGs to improve quality, outcomes, strategy and financial performance in local services, it added, but not at the expense of ‘distorting the patient-doctor relationship or clinical decision-making’.
The report said it is ‘essential’ that CCGs have a role in primary care development.
But it warned: ‘The fact that CCGs will not have formal responsibility for performance management of primary care weakens the potential for them to drive improvements in the part of the NHS dealing with the majority of patients.’
The report warned that the NHS Commissioning Board (NCB) may not be fully aware of the resources it will need to manage more than 8,000 GP contracts.
It recommends that the NCB should have ‘power to delegate to CCGs responsibility for managing contracts with GP practices’.
Under the current plans, the report said that too little was being done to take advantage of the opportunities the government’s NHS reforms offer to ‘drive improvements in primary care through strengthened local clinical leadership’.
Overall, the report said that the establishment of the NCB could solve a longstanding problem with NHS commissioning, but carried risks.
‘The absence of a national body that concentrates on commissioning has been a weakness for the NHS in the past,’ the report said.
But it warned that the Board would have to avoid widening its remit too far and undermining local commissioners.
NHS Confederation chief executive Mike Farrar said: ‘We strongly welcome the creation of the NHS Commissioning Board. We want and need it to be successful. If it isn't, the whole NHS is going to have a very big problem, especially with the current financial pressures building daily.’
The report called for clarity on how the NCB would convert NICE advice into commissioning guidance. This guidance should not be mandatory, but there should be a duty on CCGs to ‘explain their rationale’ if they chose not to follow it.
The role of clinical senates and networks should be made clear by the government, the report added. They should be advisers to CCGs based at the NCB, and not have a performance management role.
CCGs should have a say in appointing their members, the report added, and must not be held back by slow development of these groups.