Commissioning Primary Care Services: Concepts and Practice

Abstract

Chapter 5 reports research on the more recent policy of allowing CCGs to commission primary care services. In 2014 CCGs were invited to volunteer to take on responsibility for commissioning services from their member GP practices in addition to their wider responsibilities for commissioning acute and community services. In this chapter we explore the history of primary care commissioning and financing in England, and discuss the broad policy objectives which underpinned this significant change in CCGs role and scope. These objectives include the need to move to a ‘place-based’ approach to commissioning, and the need for a more effective linkage between the commissioning of primary and secondary care services in order to support movement of services into the community. Over time, most CCGs have moved to take on full delegated responsibility for commissioning GP services, and have established functioning primary care commissioning committees, with little evidence of significant problems associated with conflicts of interest. The development of local additional ‘quality contracts’ and investment in infrastructure and premises have been important issues, with few CCGs seeking to establish larger scale contractual changes. There have been significant local legacy issues in some areas relating to unclear contracts and poor handover of responsibilities from NHS England. The current legislation, under which statutory responsibility for commissioning primary care services remains with NHS England and is delegated rather than transferred to CCGs, presented some problems, particularly for those CCGs who wished to work together across a broader geographical footprint.