Let Me Introduce You to the CCG

In our attempts to keep our local GP surgery open, we have to deal with a body called the CCG.

This stands for Clinical Commissioning Group. All areas of the UK have them.

They were created three years ago, after another major upheaval in the way the NHS is run, through the creation of the Health and Social Care act in 2012.  The job of the CCG is to replace what Primary Care Trusts used to do.

The NHS Clinical Commissioning Group website explains this better:

‘CCGs are responsible for the health of their entire population, and are measured by how much they improve outcomes.’

They control around 60% of the NHS budget yearly. This is currently around £60 million.

They consist of administrators, lay people, nurses, and GPs, all of whom are elected, and who are mandated to act in the best interests of the community they serve.

CCGs work with NHS UK.

NHS UK are responsible for the whole country, and have a duty of care to ensure that what each CCG is doing is:

‘fit for purpose, and are improving health outcomes.’

CCGs also work closely with local councils, particularly the Health and Wellbeing board, to ensure that the focus is on the patients in the community.

We are having issues with our CCG.

Specifically our issue is that the CCG are closing local surgeries and not providing alternative, safe and practical options for patients to register with other surgeries. We are still having patients turned away and fobbed off by other surgeries. Stories come in to us every day since the day the closure letter came out.

We have raised the question of what the CCG has done to try and help our practice stay open. We have had to apply under the Freedom of Information Act to find this out.

We have raised the question of what funding is available to help.

This question is particularly interesting. The only answer we have been given so far is that our CCG are not able to fund what we ask for and that this type of funding is not their responsibility.

I refer you to the above quotation, directly from the NHS CCG website.

We have also asked whether there is a conflict of interest which may be affecting the outcome of our request. We note that one of the members of our CCG has a practice which is in our GP catchment area, and is being recommended by the CCG as one of the surgeries we may now want to register with. We believe that there must be a procedure in place to deal with these things ethically, as local GPs are regularly included on CCG boards. We have still had no answer to this question however.

We looked into the matter and found that CCGs regulate themselves. We are troubled by this. We found our reservations are shared by The Kings Fund, who are a research body, often employed by the NHS (and whose papers we are reading on the founding of super surgeries, funded by amongst others East Midlands health care trusts):

‘although new guidance for co-commissioning has tightened up CCG governance processes, the approach to assurance is still reactive, based on CCG self-certification and investigations by exception.’

Given that one of the major stories of last year was the phone hacking scandal which clearly demonstrated amongst other, more sobering things, that having journalists be the watchdog for journalists is not a good plan, I fail to see how a CCG monitoring and regulating their own activities can hope to pan out any better.

At a more general level, we note:

Our CCG is underperforming nationally. There are freely available statistics to prove this. Its rating is slipping year on year in relation to the national average. You would think this would encourage them to work harder to achieve their objectives and not exacerbate what they already freely admit is a crisis.

As I told you in yesterday’s post, Leicester city is one of the worst affected areas in the country by the drain of GPs. We have forty long term GP vacancies which the CCG are struggling to fill, despite using public funding from the Health and Wellbeing Board to offer golden handshakes to new GPs.

They also spent £600,00 of their funds to bring physician practitioners from the USA to Leicester to practice to help relieve the crisis.


Our CCG should be measured by the way it is improving outcomes. It should be measured by the health and wellbeing of our community.

There is concrete proof that the health and wellbeing of our community is suffering as a direct result of what the CCG are doing.

We asked NHS UK to look into this, as the regulating body responsible for monitoring what the CCG do and how they do it.

Their response, was an almost verbatim copy of the letter that the CCG sent to us when they announced the closure of our surgery.

It seems that the only health and wellbeing the CCG and NHS UK are interested in, are their own. If all they do is cover each other’s backs, who will cover ours?

Who is covering yours?


4 responses to “Let Me Introduce You to the CCG

  1. Yes. Although what is happening in Leicester (and elsewhere) is not what the CCGs were originally designed to do. Originally they were an organisation of local GPs to commission *secondary* care (ie. hospitals, audiology, etc.) only. All GPs were commissioned by NHS England, with whom they have their contract.

    A year or so ago CCGs were allowed to bid to commission GP services (*primary* care) in their area. From memory there were 3 options: (1) leave it to NHS England, ie. the status quo; (2) co-commissioning where the CCG work with NHS England to commission GPs; and (3) full responsibility where everything is devolved from NHS England to the CCG. Leicester City were one of the first tranche of 64 to be given full responsibility in Feb 2015 (see https://www.england.nhs.uk/2015/02/commissioning-of-gp/).

    Yes, this is a conflict of interest — the NHS is full of them! Where are the checks and balances? F*cked if I know. But you might like to look at https://www.england.nhs.uk/commissioning/ccg-auth/. Which as you’re finding out is deeply troubling.

    What are your Healthwatch organisation doing to help? They are supposed to be there to represent the patients’ voices and be part of the checks and balances. They do have the ear of the local authority and the CCG; and they can report concerns upwards to Healthwatch England (who have a formal route to the minister) and to CQC. There’s nothing to stop you phoning Healthwatch England (http://www.healthwatch.co.uk/talk-us), 03000 68 3000 — tho’ no clue if it’ll do any good.

    Sorry I can’t offer any magic bullets, or even anything much by way of escalation paths. I was going to suggest a call to the Parliamentary & Health Service Ombudsman (http://www.ombudsman.org.uk/) but they seem to be a completely toothless organisation.

    Oh, and if the King’s Fund says it, you may believe it. They’re outside the NHS and the political arena and don’t seem to have an axe to grind.

    Sorry, wish I could help more! xx

  2. Just had another thought. What about a phone call to the National Audit Office, https://www.nao.org.uk/contact-us/? I’m not sure if that’s an appropriate mechanism, but you’ve nothing to lose.

  3. And of course if anyone has enough money for the lawyers, you can always go to the High Court to seek a Judicial Review.

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