Area of work:

As clinical commissioning groups complete the process of being authorised as 'fit to commission' by NHS England and settle into their central role in the reformed NHS, the full scale of the challenges they face is becoming clear. This joint project by the Nuffield Trust and The King’s Fund aims to understand the development of these important new groups, and to support them by spreading good practice and learning.


Watch an audio slideshow, where Holly Holder, Fellow in Health Policy, explores the engagement of CCG members after one year.

The success of the landmark 2012 NHS reforms rests largely upon these brand new organisations being able to set local priorities for health, manage substantial commissioning budgets, and make significant changes to the location of care where their predecessors have often failed.

Clinical commissioning groups (CCGs) will be facing these difficult and complex challenges at a time when the wider health and social care system is racing to reflect a new emphasis on quality, and to find ways to live within ever-tightening budgets.

We are studying six clinical commissioning groups from across England to better understand their development and the challenges they face

In recognition of the importance of this issue, the Nuffield Trust and The King’s Fund have come together to undertake work to help policy-makers understand the development of, and the challenges facing, new clinical commissioners, and to support local commissioning groups by spreading good practice and learning.

To track the progress of these new clinical commissioning groups, we are studying six groups from across England. The study began in September 2012 and will last for three years.

In the first year, the work focused on understanding the emerging structures and governance of clinical commissioning groups, paying particular attention to the relationships that are developing between governing bodies and local GP practices.

Through interviews, observations and surveys, the project team is seeking to understand how these new commissioners are working with local GPs to influence the quality and extent of primary care services.

In subsequent phases, the project will explore how clinical commissioning groups make progress as they move beyond their initial set-up stage and how they are taking responsibility for the improvement of health and care across a whole locality.

A key interest throughout the project is the extent to which new clinical commissioners differ from previous forms of commissioning organisation (principally primary care trusts) and whether they are likely to be more or less effective in bringing about change to local health services.

Programme Outputs

Clinical commissioning groups: One year on (April 2014). This audio slideshow has been published by the Nuffield Trust and The King’s Fund to mark the one-year anniversary of CCGs fully taking up their role. It draws on surveys carried out as part of our ongoing work with the six case study areas, exploring GP engagement with the new groups and the increasing CCG involvement in raising the standards of general practice.

Clinical commissioning groups: Supporting improvement in general practice? (July 2013) this report, published by The King’s Fund and the Nuffield Trust is one of the first studies to be conducted into the early experiences of CCGs. It describes the alternative perspectives of CCG leaders and member practices when it comes to perceptions of CCG ‘ownerships’ and recommends practical steps that CCGs can take to increase member engagement and participation in clinical commissioning.

Project leads and advisors

This is a joint programme of work between the Nuffield Trust and The King’s Fund. The Nuffield Trust project team is led by Senior Fellow Natasha Curry, Fellow in Health Policy Holly Holder, and Specialty Registrar in Public Health Dr Louise Marshall; with Director of Policy Dr Judith Smith and Senior Fellow Dr Rebecca Rosen acting as advisors to the project. The King's Fund project team is led by Ruth Robertson and Shilpa Ross.

Timings for this work

This project will continue until 2015, with an interim report each year describing findings to date.

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