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English clinical commissioning groups: how to ensure their first birthday isn’t their last

BMJ 2014; 348 doi: (Published 02 April 2014) Cite this as: BMJ 2014;348:g2306
  1. Jonathan Shapiro, independent policy analyst, Birmingham
  1. jsx{at}

General practitioners need to be given the resources and flexibility to become truly responsible and accountable for the healthcare of the populations they serve, says Jonathan Shapiro

It is more than a year since clinical commissioning groups (CCGs) formally came into existence in England, and although strategic plans are beginning to emerge, CCGs continue to struggle with an infrastructure originally designed to control a national system.

The 2012 Health and Social Care Act saw CCGs as the mainspring of commissioning, capitalising on general practitioners’ twin roles: dealing with patients at the “front door” of the NHS and referring and coordinating their journeys through its complex institutional pathways when necessary.1 The notion was that general practitioners’ (albeit anecdotal) knowledge of local services could be synthesised to inform operational and strategic commissioning throughout the NHS. Giving CCGs the freedom to change services in their local health economies was intended to encourage innovative models of care that were more user friendly and better value for money.

However, CCGs’ leaders found themselves the late arrivals at a party in full swing. NHS England had already established the ground rules, subsumed specialist commissioning2 and primary care, and determined how CCGs should work and be managed. And to add …

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