Clinical Commissioning Groups (CCGs)
Last Updated: May, 2019
On the left,  Simon Stevens  standing next to David Hambleton the CEO of South Tyneside CCG. On the right is Iain Malcolm leader of South Tyneside Council, Chair of the South Tyneside  Health and Wellbeing Board  and until April 1st 2019 was a paid Non-Executive Director of South Tyneside  Foundation Trust 

CCGs were created by the  2012 Health and Social Care Act . Along with  NHS England  and  Local Area Teams  they replaced  Strategic Health Authorities  and  Primary Care Trusts .

CCGs are assisted by  Commissioning Support Units  and  Clinical Senates .

CCGs allocate the central government funding stream. They purchase everything except some specialist care and primary care (although this may change), and thus decide where NHS funds are spent in the local health economy. They are increasingly purchasing services from private companies and with tighter criteria leading to rationing of treatment and services.

CCGs are notionally headed by GPs, but in reality only a small number are on the Boards of CCGs. Further more, 36 percent of the 1179 GPs in executive positions have a financial interest in a for-profit private provider from which their CCG could potentially commission services, and this does not even include their own general practice.

GPs have generally lost interest in CCGs as they have realised how little influence they (GPs) have. CCGs have to follow the diktats from NHS England and central government, and try to make ends meet with insufficient budgets.

Responsibility for saving money has been deliberately devolved to CCGs. This enables government and NHS England to claim that they are not responsible for local cost-cutting plans, and local CCGs can claim that they do not set the budget and simply have to make ends meet, usually by closing acute services and NHS hospitals, all of which dovetails nicely with the plans for  Integrated Care .

Unlike the Primary Care Trusts that they replaced, CCGs do not have to provide health services to everyone living in their area, only to those registered with a GP. This is an important distinction because it allows for the exclusion of patients, and in this way CCGs act like primitive health insurance pools.

CCGs are able to decide what services will be free at the point of delivery. CCGs can also decide what is appropriate as part of the health service, this does away with the requirement to provide comprehensive care, and as we are seeing it permits treatments to be withdrawn from the list of provided services.

CCGs are required by Section-75 of the 2012 Health and Social Care Act to put health services out to competitive tender (except in rare circumstances), and are drawing up ever more far-reaching plans to contract out services.

Nick Seddon, who was David Cameron's Health Advisor, stated that CCGs could be used as the basis to move towards a mixed funding insurance model. The £80-billion budget could be allocated to insurers in professional alliances with GP groups ...those who can afford to would be encouraged to contribute more towards their care packages. Seddon went on to work for the UK branch of  UnitedHealth  - Optum.