Failing CCGs may have their powers transferred, as new rating systems come into play

New guidance distributed by NHS England this week, formally outlined that struggling Clinical Commissioning Groups (CCGs) could have their powers transferred to other CCGs, local authorities or providers.

The guidance explains how special measure can be used for CCGs in the future being “applied to a CCG facing persistent performance, financial or governance problems where it cannot demonstrate the leadership capability and capacity to deliver improvement on its own”.

Following its implementation, NHS England will closely oversee and work with the concerned CCG for a year after imposing special measures. These can then be removed if the CCG has been deemed to have sufficiently improved or, if the CCG is found to be slightly underachieving after the 12 month period, the measures can be extended for a reasonable time period. If the CCG has not made the expected progress NHS England can apply its powers of direction.

NHS England’s chief executive Simon Stevens declared that the organisation is going to be ‘more vigorous’ with struggling CCGs, doing their best to work together and improve those affected.

However, in cases where CCGs have “not made expected progress” after one year, the NHS can “trigger changes in the management, governance or structure of the CCG’s responsibilities, with the potential for other CCGs or relevant bodies to take over aspects of the local commissioner’s responsibilities”.

So far this new measure has not been utilised and NHS England has not yet placed any groups in special measures. In addition, although the law allows NHS England to take control of CCGs or pass their responsibilities to other CCGs, it is not yet clear whether it has the legal powers to transfer them to local authorities or providers.

However, thorughout 2015, NHS England has shown it is not afraid to act, having utilised its powers of legal direction against four CCGs so far. The 2015-16 assurance framework will also see CCGs rated for the first time, with rankings descending respectively from ‘outstanding’, ‘good’, ‘limited assurance’ or ‘not assured’. These rankings will not be used until the end of the financial year.

Further CCG guidance released this week, titled ‘CCG assurance operating manual’, refers to the introduction of a new ‘scorecard’ rating for CCGs. The scoring is based on quality indicators and judgements on capability. The guidance was a result of a request by the Health Secretary Jeremy Hunt who called for the new rating system to be developed and results published on the MyHealth website. Mr Hunt later requested the collaboration of King’s Fund Chief Executive, Chris Ham, and NHS England in the development of the system. The aim is to provide a “clear, common information source for assurance.” However, the scoring system will not be introduced until 2016-17.

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