Clinical commissioning groups (CCGs) were National Health Service (NHS) organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integrated care systems as a result of the Health and Care Act 2022.
Establishment
The announcement that GPs would take over this commissioning role was made in the 2010 white paper "Equity and Excellence: Liberating the NHS". 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. 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, but a series of mergers had reduced the number to 135 by April 2020.
To a certain extent they replaced primary care trusts (PCTs), though some of the staff and responsibilities moved to local authority public health teams when PCTs ceased to exist in April 2013. Services directly provided by PCTs were reorganised through the Transforming Community Services programme.
Structure and membership
Clinical commissioning groups (CCGs) were clinically led groups which included all of the GP groups in their geographical area. They worked with patients and healthcare professionals and in partnership with local communities and local authorities. 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. The aim of this was to give GPs and other clinicians the power to influence commissioning decisions for their patients. 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. CCGs were overseen by NHS England including its Regional Offices and Area Teams. These structures managed primary care commissioning, including holding the NHS Contracts for GP practices NHS.
Each CCG had a constitution and was run by its governing body. Each had to have an accountable officer responsible for the CCG's duties, functions, finance and governance. Most CCGs initially appointed former primary care trust managers to these posts. However, by October 2014, only a quarter of accountable officers were GPs, whereas 80% of CCG Chairs were GPs. By November 2014 only half of GP practices said they felt involved in CCG decision-making processes.
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. More than 400 CCG board members were shareholders in such companies. The King's Fund and the Nuffield Trust ran a survey of GPs in six areas of England in 2016 and found that more than 70% were at least "somewhat" engaged with the work of their CCG, though only 20% of those without a formal role in their CCG said they could influence the work of their CCG if they chose to.
Mergers
In 2013, 211 groups were established and there was resistance to any proposals for mergers between groups. On 1 April 2015 Gateshead CCG, Newcastle North & East CCG and Newcastle West CCG merged, yet in the same year, Lakeside Healthcare applied to move from Corby CCG where it had two-thirds of the registered population to Nene CCG, but Nene refused to accept it. During 2016 it appeared that further mergers would be permitted, and in November 2016 NHS England published an official procedure. In March 2017, 83 CCGs were sharing chief officers as a precursor to merger. During 2017 mergers between CCGs began, having previously been forbidden. As of August 2017 GPs in Staffordshire submitted a vote of no confidence in their local CCGs in protest against a proposed merger. The merger between Liverpool, South Sefton and Southport and Formby CCGs was stopped while an investigation into Liverpool CCG's governance and management of conflicts of interest was carried out, leading to the resignation of several of its leaders. There were similar investigations in Hackney, London and Crawley.
As of April 2018, the largest CCG in England was created following the merger of NHS Birmingham Cross-City, Birmingham South Central and Solihull CCGs. The newly formed NHS Birmingham and Solihull CCG became responsible for commissioning services for over 1.3 million patients.