The view from commissioners: Reconsidering accountability in an age of integrated care

In his viewpoint paper recently published by the Nuffield Trust, Ben Jupp raised issues of accountability with changing NHS structures. And it is tempting to focus on structures and organisations when discussing the NHS and the health outcomes of local people. Politicians have proposed measures such as changing responsibilities or the mandatory pooling of budgets to improve health. But I would argue that we already have the structures in place to deliver improvements to population health. We should focus first on improving health outcomes for our patients, and allow the system to evolve – not get distracted by structural reorganisations.

Concerns that conflicts of interest between GPs as commissioners and GPs as providers of care would hinder decision making have so far proved unfounded.

CCGs were created with one simple idea: to harness the expertise and local knowledge that front-line GPs and clinicians could bring to commissioning. Clinically led commissioning is a strategic function. It uses the insights of clinical professionals, with our face-to-face relationship to patients, to help understand the health and wellbeing of local populations, and map out their needs for the long term. It is also capable of delivering on financial expectations in a highly challenging fiscal environment.

Concerns that conflicts of interest between GPs as commissioners and GPs as providers of care would hinder decision making have so far proved unfounded. CCGs and their governing bodies are recognising where conflicts of interest might arise and are managing them, rather than seeing them as a barrier to commissioning high-quality care in a local context.

Clinical commissioning is already delivering for patients. It continues to evolve and mature into a system that is focused on patient wellbeing as well as illness and is making a positive difference.

The recent responsibilities CCGs have taken on to commission primary care give us the opportunity to start to genuinely join up care and address some of the fragmentation in local health economies. It will also offer those involved in delivering front-line primary care the chance to become actively engaged in the commissioning process.

Health and Wellbeing Boards provide a key opportunity for joint working between organisations that have worked independently for too long. CCGs are embracing this opportunity to work at a place level alongside council colleagues to address the social, economic and health care factors that create a healthy population.

We recognise there is an urgent need to enable commissioners to achieve much more, at scale and pace. This means giving CCGs the freedoms, flexibilities and resources to make the bold, big decisions that the NHS so desperately needs.

The Vanguard process, through which NHS England is piloting the more integrated providers Ben Jupp discusses, has shown that CCGs are at the fore of developing new models of care. We are not afraid of taking bold decisions to radically change the way care is delivered to our patients. These new models will see CCGs evolve in different ways, but what is certain is the need for a strong commissioner voice which can hold these newly developing organisations to account at a local level.

Integrating health and care is critical to a safe and sustainable health service. CCGs are uniquely placed to use their clinical expertise, their roots in the community and their system leadership role to work in partnership across the health and care system to do just that and make a different for their patients. Without clinical commissioning to harness this powerful combination, it couldn’t happen.

This blog is part of a series of responses to Ben Jupp’s Viewpoint paper ‘Reconsidering accountability in an age of integrated care’. Share your own response in the comments below or on Twitter with @nuffieldtrust.

Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors' own.