Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.

CCGs are Redefining ‘Out of Hospital’ Care

As we approach the precipice of the cliff, the pressure is on. We look at the relentless tide of rising acute activity and everyone is clear, ‘something must be done!’. In order for our hospitals to be able to restructure and organise services differently, experts and management consultants tell anyone who will listen that what we need is an ‘out of hospital strategy’.

But the NHS is changing. Out of hospital (as opposed to ‘in hospital’) is no longer the distinction that is helpful in framing the changes that clinical commissioning groups (CCGs) are striving to achieve.

Most CCGs are organised around some form of locality structure.  This is where groups of practices from the same area come together and operate as the underpinning infrastructure of the CCG.  In larger CCGs there may be up to 10 localities, and smaller CCGs may be made up of as few as one locality.  The principle however holds that practices are grouped in a rational way that makes meeting and decision making sensible and practical for the relevant practices.

A key question that many CCGs are grappling with is what exactly is the role of the locality in this post-authorisation world?  Initially the importance of localities was based on the engagement of practices in the CCG (which we have discussed on this site, for example here). 

But with the ‘call to action’ and the future of general practice becoming a live issue, the priority that CCGs are giving to the transformation of general practice, the introduction of the integrated transformation fund, and the murmurings about contracting general practice and community services together (here), the importance of localities is growing, and the role of localities is changing. 

Localities are now the focal point of the transformation of community based services around general practice.  The role of the locality is to bring the practices together into some coherent form of general practice provision.  This means a move away from, say, 6 practices operating in splendid isolation, to the 6 practices operating as one unit, and acting actively bringing together community services, social services and the voluntary sector.  There is no piece of NHS infrastructure better placed to support this change than the CCG locality.

This means the locality is no longer an arbitrary grouping of practices with collective responsibility for managing a budget, but is now the practical mechanism by which care for the local community will be organised and, dare I say it, integrated around local needs.  The crude separation of general practice as commissioner and general practice as provider is removed; the advantage of general practice as both is harnessed.

CCGs are redefining ‘out of hospital care’ as ‘locality-based care’.  It starts with the redesign of general practice.  It blends in community services and social care.  It adds any existing community estate.  It is all done in partnership with the local population.  And it can move at the pace of the quickest not the slowest; not all localities have to develop at the same rate.

Herein lies the biggest challenge and opportunity for CCGs.  There is no question this is a hugely difficult task.  But as membership organisations of GP practices CCGs are uniquely placed to make this happen, and if successful have the chance to make more of an impact on the design and delivery of healthcare than any predecessor commissioning organisation in the history of the NHS.


This article was first published on October 12th, 2013 on

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