Leadership for health commissioning in the new NHS: exploring the early development of Clinical Commissioning Groups in England

“The upsurge of interest in leadership in the English National Health Service (NHS) is

a response to the government’s belief that stronger leadership is needed in the public

sector. This is because strong leadership is seen as critical to navigating transition

and uncertainty on the scale that is currently seen within the NHS” (Dopson and Mark

2003 p251)

These words were written in 2003, but are equally relevant today as the Health and Social Care Act

2012 (HSCA 2012) instigates the most extensive reorganisation of the structure of the National

Health Service (NHS) in England to date. The legislation abolished Primary Care Trusts (PCTs) and

Strategic Health Authorities (SHAs), with the majority of the commissioning budget transferred to

211 newly developing Clinical Commissioning Groups (CCGs) from April 2013. These groups are

now partly led by General Practitioners (GPs), and this significant structural change was justified as

part of the Governments’ stated desire to create a clinically-driven commissioning system that is

more sensitive to the needs of patients. At the same time, other parts of the NHS have undergoing

parallel changes, also aimed at increasing clinical leadership of the service (NHSCB 2011a). In this

paper we explore the early experiences of those involved with the development of CCGs, looking at

how this aspiration towards a ‘clinically-led’ system is playing out in practice. We investigate two

leadership approaches previously identified in the literature as being important in the context of

major change – responsible guardianship and positive deviancy (Allen and Wade 2011). What

follows is divided into five sections. A brief description of the scope and nature of the current

changes affecting the English NHS is followed by a brief discussion of relevant literature relating to

the concept of ‘leadership’ Our methods will then be described, and the results of the study reported,

with a final discussion section exploring the significance of these findings for NHS policy and

practice.