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NAO review of the role and costs of clinical commissioning groups

20 December 2018

This National Audit Office review sets out the role, costs and performance of CCGs, the changing commissioning landscape and the future of CCGs.

Read report, summary and NAO press release

Clinical commissioning groups (CCGs) are clinically-led statutory bodies that have a legal duty to plan and commission most of the hospital and community NHS services in the local areas for which they are responsible. They were established as part of the Health and Social Care Act in 2012 and replaced primary care trusts on 1 April 2013.  

This review sets out:

  • changes to the commissioning landscape before CCGs were established;

  • the role, running costs and performance of CCGs; and

  • the changing commissioning landscape and the future role of CCGs.

Over half of CCGs were rated by NHS England as either ‘outstanding’ or ‘good’1 in 2017-18, but more than 40% were rated as either ‘requires improvement’ or ‘inadequate’, with 24 CCGs deemed to be failing, or at risk of failing.

While most stakeholders provide a positive view of their engagement with CCGs, neither the Department of Health and Social Care nor NHS England have undertaken an overall assessment of CCGs’ progress in achieving their policy objectives since they were introduced.

The structure of CCGs is evolving, with mergers, shared senior management teams and increasing joint working. This is being prompted by factors including wider changes across the NHS, budgetary pressures and as CCGs’ understanding of the most appropriate commissioning structure for their local area develops. For example, there have been eight mergers of CCGs since 2013. Most CCGs now share accounting officers and some are establishing joint commissioning arrangements with their local authority. This trend is expected to continue, which will likely lead to fewer CCGs covering larger populations.

Their larger scale is intended to help with planning, integrating services and consolidating leadership capability, but there is a risk that working across greater populations will make it more difficult for CCGs to design local health services that are responsive to patients’ needs.