Clinical commissioning group
This was part of the government's stated desire to create a clinically driven commissioning system that was more sensitive to the needs of patients.
On their governing body, each group had, in addition to GPs, at least one registered nurse and a doctor who was a secondary care specialist from an area not covered by the CCG's boundaries.
[1][6] The Health and Social Care Act 2012 provided that the areas specified in the constitutions of clinical commissioning groups together cover the whole of England, and did not coincide or overlap.
[10] Unite the Union surveyed the 3,392 CCG board members in 2015 and reported that 513 were directors of private healthcare companies: 140 owned such businesses and 105 carried out external work for them.
[citation needed] In November 2018, NHS England announced that the administration budgets of CCGs were to be cut by 20% and that mergers, which would be approved, were a good way of saving money.
The board was to commence work in April 2018 and provide full service a year later, preventing duplication of health and social care within the city.
[24] In 2017 it was proposed that most CCGs should take responsibility for GP contracts, as the early adopters had done well and it was "critical to local sustainability and transformation planning".
[27] In April 2018, in a dispute brought by City of Wolverhampton Council against Shropshire and South Worcestershire CCGs over their failure to meet the continuing healthcare costs for a patient with learning disabilities, Mr Justice Garnham ruled that a CCG could not pay for treatment of a patient registered with a general practitioner outside their area.
[31] According to Christian Mazzi, head of health at Bain & Company, in September 2015 70% of CCGs had failed to monitor their private sector contracts or enforce quality standards.
The General Medical Council guidance, Financial and commercial arrangements and conflicts of interest provides that a doctor should "not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients" but the council accepted that "Finance and other incentives can be an effective way of driving improvements in healthcare.
[35] A similar July 2015 survey by the GP magazine Pulse, found that many CCGs were planning to restrict access to routine care in various ways.
Nottinghamshire CCGs had restricted access to surgery for sleep apnoea and hysterectomy for heavy menstrual bleeding, fat grafts, hair depilation, earlobe repair, and chin, cheek or collagen implants.
[37] In view of the coronavirus pandemic, on 23 and 27 March 2020[38] the Secretary of State for Health and Social Care directed the NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs.
[42] In 2014 NHS England investigated Wirral Clinical Commissioning Group after Birkenhead MP Frank Field raised concerns about it.
They found that the chair and chief clinical officer "did not demonstrate the necessary close working agreement" about what needed to change within the CCG.
After the report was published Field repeated his calls for the senior officers to stand aside while a new constitution is made for the governance of the group.
[47] Bristol CCG were subject to a legal challenge from a local pressure group, Protect Our NHS, who claimed that their processes for involving patients and the public in their decisions were inadequate.
A judicial review was withdrawn in June 2014 after the CCG agreed to amend its patient and public involvement strategy and other documents.
