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Clinical commissioning group


Clinical commissioning group

Clinical commissioning groups (CCGs) are NHS organisations set up by the NHS services in England. [1]

To a certain extent they replace primary care trusts (PCTs), though some of the staff and responsibilities moved to the council Public Health teams when PCTs ceased to exist in April 2013.


  • Structure and membership 1
  • Operation 2
  • History 3
  • Authorisation 4
  • Regulation 5
  • Public involvement 6
  • See also 7
  • References 8
  • External links 9

Structure and membership

CCGs are clinically led groups that include all of the GP groups in their geographical area. The aim of this is to give GPs and other clinicians the power to influence commissioning decisions for their patients.[2][1]

CCGs are overseen by NHS England (including its Regional Offices and Area Teams). These structures manage primary care commissioning, including holding the NHS Contracts for GP practices NHS.[3]

Each CCG has a constitution and is run by its governing body. Each has to have an accountable officer responsible for the CCG’s duties, functions, finance and governance. Most CCGs initially appointed former PCT managers to these posts.[4] Only a quarter of accountable officers were GPs in October 2014, but 80% of CCG Chairs were GPs.[5] Only half of GP practices said they felt involved in CCG decision making processes.[6]


CCGs operate by commissioning (or buying) healthcare services including: [1]

  • Elective hospital care
  • Rehabilitation care
  • Urgent and emergency care
  • Most community health services
  • Mental health and learning disability services

Clinical commissioning groups work with patients and healthcare professionals and in partnership with local communities and local authorities. On their governing body, Groups will have, in addition to GPs, at least one registered nurse and a doctor who is a secondary care specialist. Each CCG has boundaries that are coterminous with those of local authorities, though one authority may have several CCGs. Clinical commissioning groups are responsible for arranging emergency and urgent care services within their boundaries, and for commissioning services for any unregistered patients who live in their area. All GP practices must belong to a clinical commissioning group.


The announcement that GPs will take over this commissioning role was made in the 2010 White Paper, "Equity and Excellence: Liberating the NHS". This is part of the Government's wider desire to create a clinically driven commissioning system that is more sensitive to the needs of patients. The 2010 White Paper became law under the Health and Social Care Act 2012 in March 2012.

At the end of March 2013 there were 211 CCGs.[7]


All CCGs had to go through an authorisation process. There were four waves of authorisation between July and December 2012.[8]


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. There were also questions about the relationship senior leaders had with Arrowe Park Hospital. 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.[9]

In October 2014 it was reported that NHS England were considering a special measures regime for CCGs in difficulties, of which there were said to be about a dozen. Under the current assurance framework, CCGs are rated as “assured”, “assured with support” or “not assured”. Only Barnet CCG is been rated “not assured”.[10]

Public involvement

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.[11]

See also


  1. ^ a b c "Health and Social Care Act 2012 Schedule 2". UK Government. Retrieved 17 Apr 2013. 
  2. ^ "Bureaucrats return to lead doctors' groups".  
  3. ^ "About us". NHS England. Retrieved 17 Apr 2013. 
  4. ^ "Exclusive: over 60 per cent of CCGs choose PCT manager as their leader". Health Service Journal. 14 March 2012. Retrieved 2 November 2014. 
  5. ^ "GPs hold only a quarter of accountable CCG roles". Health Service Journal. 16 October 2014. Retrieved 2 November 2014. 
  6. ^ "Fall in GP engagement with CCGs, NHS England survey finds". Health Service Journal. 20 October 2014. Retrieved 2 November 2014. 
  7. ^ "Bulletin for CCGs Issue 31". NHS England. Retrieved 17 Apr 2013. 
  8. ^
  9. ^ "Critical report says relationship between senior leaders at Wirral health authority has held it back". Liverpool Echo. 10 September 2014. Retrieved 2 October 2014. 
  10. ^ "Troubled CCGs could face 'special measures' regime". Health Service Journal. 16 October 2014. Retrieved 2 November 2014. 
  11. ^ "CCG amends involvement strategy as procurement judicial review withdrawn". Local Government Lawyer. 13 June 2014. Retrieved 9 July 2014. 

External links

  • Health and Social Care Act 2012 - full legislation
  • NHS England website
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