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Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS

Checkland, Kath, Allen, Pauline, Coleman, Anna, Segar, Julia, Mcdermott, Imelda, Harrison, Stephen, Petsoulas, Christina, Peckham, Stephen (2013) Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS. BMJ Open, 3 (12). ISSN 2044-6055. (doi:10.1136/bmjopen-2013-003769) (KAR id:37478)


Objective: One of the key goals of the current reforms in the English National Health Service (NHS) under the Health and Social Care Act, 2012, is to increase the accountability of those responsible for commissioning care for patients (clinical commissioning groups (CCGs)), while at the same time allowing them a greater autonomy. This study was set out to explore CCG’s developing accountability relationships.

Design: We carried out detailed case studies in eight CCGs, using interviews, observation and documentaryanalysis to explore their multiple accountabilities.

Setting/participants: We interviewed 91 people,including general practitioners, managers and governing body members in developing CCGs, and undertook 439 h of observation in a wide variety of meetings.

Results: CCGs are responsible to a managerial, sanction-backed accountability to NHS England (the highest tier in the new organisational hierarchy), alongside a number of other external accountabilities to the public and to some of the other new organisations created by the reforms. In addition, unlike their predecessor, commissioning organisations, they are subject to complex internal accountabilities to their members.

Conclusions: The accountability regime to which CCGs are subject to is considerably more complex than that which applied their predecessor organisations. It remains to be seen whether the twin aspirations of increased autonomy and increased accountability can be realised in practice. However, this early study raises

some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing (or conflicting) agendas, and the lack of clarity over the operation of sanction regimes.

Item Type: Article
DOI/Identification number: 10.1136/bmjopen-2013-003769
Uncontrolled keywords: Accountability; Case Study Research; Clinical Commissioning Groups
Subjects: H Social Sciences > HJ Public Finance
R Medicine > R Medicine (General) > R729 Types of medical practice > R729.5.G4 General practice
R Medicine > RA Public aspects of medicine
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Stephen Peckham
Date Deposited: 11 Dec 2013 09:47 UTC
Last Modified: 16 Nov 2021 10:14 UTC
Resource URI: (The current URI for this page, for reference purposes)

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