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54-503: The partnership was selected as the preferred bidder by NHS Cambridgeshire and Peterborough Clinical Commissioning Group as Lead Provider of older people's healthcare and adult community services, able to integrate services, with the intention providing more joined-up care for patients. This decision came after a 15-month service design and procurement process and the partnership started delivering services on 1 April 2015. Commonly NHS contracts are just one or two years in length. This contract

108-860: A Federated Data Platform (FDP). An FDP would enable every hospital trust and integrated care system (ICS) to have their own platform through which they could connect and share information between them where helpful. The FDP would build on the work done with the Covid Data Store .The contract to provide the FDP would be worth up to £480 million. Palantir are widely thought to be the frontrunners to win. This has prompted further criticism from civil liberties groups. Specialised services are those provided in relatively few hospitals and accessed by comparatively small numbers of patients, but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit

162-610: A clinical commissioning group. The area of the CCG had to all be within one top-tier local authority . As originally established, CCGs did not have any responsibility for primary care which was commissioned and managed by NHS England , but in November 2014 they were invited to become co-commissioners of primary care in their area, responsible for the performance management and budgets of their member GP practices, including managing complaints about practices and GPs. A delegated commissioning model

216-701: A clinically driven commissioning system that was more sensitive to the needs of patients. The 2010 white paper became law under the Health and Social Care Act 2012 in March 2012. At the end of March 2013 there were 211 CCGs, but a series of mergers had reduced the number to 135 by April 2020. To a certain extent they replaced primary care trusts (PCTs), though some of the staff and responsibilities moved to local authority public health teams when PCTs ceased to exist in April 2013. Services directly provided by PCTs were reorganised through

270-547: A document known as the NHS mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to the mandate. In 2018 it was announced that the organisation, while maintaining its statutory independence, would be merged with NHS Improvement , and seven "single integrated regional teams" would be jointly established. NHS England

324-425: A good way of saving money. For 2020, 86 mergers were planned; 45% of the existing 191 groups. As of April 2020 there were 135 CCGs. On 1 April 2021, 38 CCGs merged to form 9 new CCGs. In October 2017, it was announced that Brighton and Hove Clinical Commissioning Group were to merge some services with those provided by Brighton and Hove City Council , via a Health and Social Care Integration Board. The board

378-452: A team of staff with the appropriate expertise. NHS England is responsible for commissioning £19.3 billion of specialised services in 2021-2 and for dealing with Individual Funding Requests in respect of the specialist services it commissions. There are proposals to move some of this commissioning to integrated care systems . The Shelford Group expressed concerns in May 2022 about services "where

432-701: A variety of support functions, largely staffed by former employees of the primary care trusts . All CCGs were told that they must procure support services by a tender process by April 2015. The first tender, by South Lincolnshire and South West Lincolnshire CCGs was won by OptumHealth with a value of £3 million a year for three years. By 2017 the number of commissioning support lists had been reduced to eight. In September 2015 at least 9 CCGs had set up "ethically questionable" incentive schemes to persuade GPs to reduce referrals for new outpatient attendances, follow-ups, A&E attendances and emergency admissions with payments per practice of up to £11,000. Chaand Nagpaul , of

486-478: A vote of no confidence in their local CCGs in protest against a proposed merger. The merger between Liverpool , South Sefton and Southport and Formby CCGs was stopped while an investigation into Liverpool CCG's governance and management of conflicts of interest was carried out, leading to the resignation of several of its leaders. There were similar investigations in Hackney, London and Crawley . As of April 2018,

540-656: Is the operating name of the NHS Commissioning Board and, before that, the NHS Commissioning Board Authority. It was set up as a special health authority of the NHS in October 2011 as the forerunner to becoming a non-departmental body on 1 April 2013. It was renamed NHS England on 26 March 2013, although its legal name remains the NHS Commissioning Board. Sir David Nicholson , who became Chief Executive at

594-428: Is their best or only option, have no hope of access to funding. Most have been waiting many months. Approximately half of these patients are at imminent risk of a catastrophic event (renal bleed or kidney failure) with a high risk of preventable death." It authorises and pays for treatment of narcolepsy with sodium oxybate by means of individual funding requests on the basis of exceptional circumstances. In May 2016

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648-483: The Health Service Journal found that more than a third were planning to save money by restricting access to services, i.e. health care rationing , particularly on "procedures of limited effectiveness", podiatry, in vitro fertilisation, and limiting access to procedures based on aspects of a patient's health, for example whether they smoke or are obese, which can affect outcomes. A similar July 2015 survey by

702-588: The British Medical Association , condemned them as "a financial contaminant" to patient-doctor trust. The General Medical Council guidance, Financial and commercial arrangements and conflicts of interest provides that a doctor should "not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients" but the council accepted that "Finance and other incentives can be an effective way of driving improvements in healthcare." An April 2015 survey of CCGs by

756-644: The London Borough of Tower Hamlets Clinical Commissioning Group, chaired by Sam Everington , was awarded Clinical Commissioning Group of the year by the Health Service Journal for "strong leadership, especially around clinical leadership, while retaining patient focus." In May 2015, a study conducted by the Open University and University College London found that clinical leaders "seemed to be more willing to challenge or ignore diktats and messages from above, and to encourage their managerial colleagues to do

810-708: The NHS Commissioning Board for England , is an executive non-departmental public body of the Department of Health and Social Care . It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the National Health Service in England as set out in the Health and Social Care Act 2012 . It directly commissions NHS general practitioners , dentists, optometrists and some specialist services. The Secretary of State publishes annually

864-468: The NHS app was unveiled, with public backing from Matt Hancock , who presented it as the key to a radical overhaul of NHS technology. The NHS Long Term Plan set a target for all secondary care providers to move to digital records by 2024, which "will cover clinical and operational processes across all settings, locations and departments and be based on robust, modern IT infrastructure services for hosting, storage, networks and cyber security." In 2020

918-526: The Transforming Community Services programme. Clinical commissioning groups (CCGs) were clinically led groups which included all of the GP groups in their geographical area. They worked with patients and healthcare professionals and in partnership with local communities and local authorities. On their governing body, each group had, in addition to GPs, at least one registered nurse and a doctor who

972-487: The continuing healthcare costs for a patient with learning disabilities, Mr Justice Garnham ruled that a CCG could not pay for treatment of a patient registered with a general practitioner outside their area. In 2018/19, £74.2 billion was distributed among the 195 CCGs in England, equivalent to £1,254 per registered patient. The funding formula allocates more money to CCGs with elderly populations, in urban areas, or in more deprived areas. The highest allocation per patient

1026-770: The coronavirus pandemic , on 23 and 27 March 2020 the Secretary of State for Health and Social Care directed the NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs. The directive also allowed NHS England to exercise functions normally carried out by CCGs, as the Board deemed appropriate. The directive had an initial expiry at the end of 2020, which was extended in stages to 31 March 2022. All CCGs had to go through an authorisation process. Between July and December 2012, there were four waves of authorisation . In 2014 NHS England investigated Wirral Clinical Commissioning Group after Birkenhead MP Frank Field raised concerns about it. They found that

1080-518: The Board deems appropriate. The direction will be in place until the end of 2020. Applications by GPs to reduce their catchment area are dealt with by NHS England. In November 2014, Mr Justice Popplewell declared that NHS England "has acted unlawfully by reason of its failure to make arrangements for the involvement of patients in primary care commissioning decisions as required by the National Health Service Act 2006". The case involved

1134-672: The GP magazine Pulse , found that many CCGs were planning to restrict access to routine care in various ways. Another Health Service Journal survey in September 2015 showed that 34 of 188 CCGs who responded to the survey had restricted access to some services. Restrictions were usually introduced by a number of CCGs acting together across an area. Nottinghamshire CCGs had restricted access to surgery for sleep apnoea and hysterectomy for heavy menstrual bleeding, fat grafts, hair depilation, earlobe repair, and chin, cheek or collagen implants. In view of

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1188-504: The High Court ordered NHS England to provide funding to treat a teenager with severe narcolepsy. The judge criticised their "thoroughly bad decision" and "absurd" policy discriminating against the girl when hundreds of other NHS patients already receive the drug. The Department of Health is also paying for the treatment of people whose narcolepsy was caused by the swine flu vaccine Pandemrix in 2009–10 by means of private prescriptions outside

1242-400: The NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs. The Exercise of Commissioning Functions by the NHS Commissioning Board (Coronavirus) Directions 2020 came into force on 20 March 2020, and were revised to widen the definition of independent providers on 27 March. The directive also allows NHS England to exercise functions normally carried out by CCGs, as

1296-578: The NHS Contracts for GP practices NHS. Each CCG had a constitution and was run by its governing body. Each had to have an accountable officer responsible for the CCG's duties, functions, finance and governance. Most CCGs initially appointed former primary care trust managers to these posts. However, by October 2014, only a quarter of accountable officers were GPs, whereas 80% of CCG Chairs were GPs. By November 2014 only half of GP practices said they felt involved in CCG decision-making processes. Unite

1350-504: The NHS awarded an emergency contract to Palantir Technologies for the creation of a Covid Data Store system for a statutory fee of £1. Palantir then won a £23.5 million contract with the NHS to continue with its work in December 2020. Palantir's involvement with the NHS was subject to criticism from civil liberties groups, including Open Democracy . In 2023 the NHS began a procurement process for

1404-509: The UK in June 2015. The organisation was reported to be developing a strategy to support the use of personal health records in June 2015. This, it is hoped, could achieve up to £3.4 billion in annual efficiency savings by 2020. In April 2016 it published an index of digital maturity, where each of the 239 NHS trusts assessed its own "readiness", "capabilities" and "enabling infrastructure". In 2018

1458-532: The Union surveyed the 3,392 CCG board members in 2015 and reported that 513 were directors of private healthcare companies: 140 owned such businesses and 105 carried out external work for them. More than 400 CCG board members were shareholders in such companies. The King's Fund and the Nuffield Trust ran a survey of GPs in six areas of England in 2016 and found that more than 70% were at least "somewhat" engaged with

1512-420: The chair and chief clinical officer "did not demonstrate the necessary close working agreement" about what needed to change within the CCG. There were also questions about the relationship senior leaders had with Arrowe Park Hospital . After the report was published Field repeated his calls for the senior officers to stand aside while a new constitution is made for the governance of the group. In October 2014 it

1566-486: The collapse of the contract, which was published in July 2016. Their verdict was that the contract "failed for financial reasons which could, and should, have been foreseen". Clinical Commissioning Group Clinical commissioning groups ( CCGs ) were National Health Service (NHS) organisations set up by the Health and Social Care Act 2012 to replace strategic health authorities and primary care trusts to organise

1620-473: The contract value will depend on performance against these indicators. On 3 December 2015 UnitingCare Partnership and Cambridgeshire and Peterborough Clinical Commissioning Group released a joint statement explaining that the contract was being terminated because they agreed it was no longer financially sustainable. The statement suggested that the service delivery model will continue for the time being. The National Audit Office undertook an investigation into

1674-468: The contract with Lewisham and Greenwich NHS Trust " until April 2019. Bristol CCG were subject to a legal challenge from a local pressure group, Protect Our NHS, who claimed that their processes for involving patients and the public in their decisions were inadequate. A judicial review was withdrawn in June 2014 after the CCG agreed to amend its patient and public involvement strategy and other documents. NHS England NHS England , formerly

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1728-471: The decision to scrap the minimum practice income guarantee. Richard Stein, a partner at Leigh Day , said the declaration could mean that patients would have to be involved in discussions on changes to the GP contract. NHS England awarded a four-year contract to Capita to become sole provider of administrative services including payment administration, management of medical records, and eligibility lists for practitioners for GPs, opticians and dentists across

1782-401: The delivery of NHS services in each of their local areas in England. On 1 July 2022, they were abolished and replaced by integrated care systems as a result of the Health and Care Act 2022 . The announcement that GPs would take over this commissioning role was made in the 2010 white paper "Equity and Excellence: Liberating the NHS". This was part of the government's stated desire to create

1836-465: The establishment of the Board, retired at the end of March 2014 and was replaced by Simon Stevens . One of Stevens' first acts was to announce a restructure of the 27 area teams, in response to a requirement to reduce running costs, which would reduce staffing by around 500. The 27 teams outside London were reduced to 12 in 2015. Amanda Pritchard , the Chief Operating Officer of NHS England,

1890-460: The group's area and were not provided with primary medical services by a member of any clinical commissioning group. CCGs operated by commissioning (or planning, buying and monitoring) healthcare services including: Clinical commissioning groups were responsible for arranging emergency and urgent care services within their boundaries, and for commissioning services for any unregistered patients who live in their area. All GP practices had to belong to

1944-520: The historical allocation was slow, and CCGs which were above their allocation did not suffer a reduction. From April 2016, however, CCGs with more than 10 per cent above their fair share were to receive "flat cash" – an effective reduction. This would also ensure than no CCG was more than 5 per cent below its target allocation in 2016/2017. In October 2016 it introduced the Operational Pressures Escalation Levels (OPEL) system for

1998-414: The largest CCG in England was created following the merger of NHS Birmingham Cross-City, Birmingham South Central and Solihull CCGs. The newly formed NHS Birmingham and Solihull CCG became responsible for commissioning services for over 1.3 million patients. In November 2018, NHS England announced that the administration budgets of CCGs were to be cut by 20% and that mergers, which would be approved, were

2052-410: The largest budget deficits. It is intended to reduce their spending by around £500 million, and health leaders were told to "think the unthinkable". In 2022 there were seven regional teams and 10,640 full time equivalent staff. NHS England allocates funding (£69.5 billion in 2016/2017) to CCGs in accordance with a funding formula. Until 2016, progress towards the amount indicated by the formula from

2106-505: The management of operational difficulties in English hospitals, replacing the system of red and black alerts which was locally defined. OPELs range from 1 (normal) to 4 (a major crisis requiring external intervention either regionally or nationally). This is intended, among other things, to enable comparisons of trends over time and between areas. In view of the coronavirus pandemic , the Secretary of State for Health and Social Care directed

2160-668: The management, governance or structure of the CCG's responsibilities, with the potential for other CCGs or relevant bodies to take over aspects of the local commissioner's responsibilities". At that time, none had been placed in special measures. In November 2015, Shropshire Clinical Commissioning Group was put in special measures after its financial position deteriorated. It expected an in-year deficit of £10.6 million for 2015/6. In September 2017, 23 CCGs were rated inadequate by NHS England for 2016–17, five were given legal directions and two, Lewisham and Greenwich, were ordered to "cease to exercise its acute commissioning functions, including

2214-481: The numbers and evidence base supports the planning and provision of care being done at a population size larger than a typical ICS footprint." In 2015 there was criticism of delays in deciding on a policy for the prescription of Everolimus in the treatment of tuberous sclerosis . Twenty doctors addressed a letter to the board in support of the charity Tuberous Sclerosis Association saying "around 32 patients with critical need, whose doctors believe everolimus treatment

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2268-466: The registered population to Nene CCG, but Nene refused to accept it. During 2016 it appeared that further mergers would be permitted, and in November 2016 NHS England published an official procedure. In March 2017, 83 CCGs were sharing chief officers as a precursor to merger. During 2017 mergers between CCGs began, having previously been forbidden. As of August 2017 GPs in Staffordshire submitted

2322-472: The same". Clinical leaders were more "focused on outcomes and less interested in processes. They don't really mind how they do things as long as they feel they're having an impact". Having the option of returning to full-time clinical practice meant that clinicians felt a "degree of freedom in what they say and do". In April 2018, in a dispute brought by City of Wolverhampton Council against Shropshire and South Worcestershire CCGs over their failure to meet

2376-456: The work of their CCG, though only 20% of those without a formal role in their CCG said they could influence the work of their CCG if they chose to. In 2013, 211 groups were established and there was resistance to any proposals for mergers between groups. On 1 April 2015 Gateshead CCG, Newcastle North & East CCG and Newcastle West CCG merged, yet in the same year, Lakeside Healthcare applied to move from Corby CCG where it had two-thirds of

2430-554: Was a secondary care specialist from an area not covered by the CCG's boundaries. The aim of this was to give GPs and other clinicians the power to influence commissioning decisions for their patients. The Health and Social Care Act 2012 provided that the areas specified in the constitutions of clinical commissioning groups together cover the whole of England, and did not coincide or overlap. CCGs were overseen by NHS England including its Regional Offices and Area Teams. These structures managed primary care commissioning, including holding

2484-424: Was appointed for each area, who is to be responsible for the implementation of the plans which are to be agreed by the component organisations. They will be "working across organisational boundaries to help build a consensus for transformation and the practical steps to deliver it". In April 2017 it introduced a capped expenditure process, applied to NHS commissioners and providers in the 13 areas across England with

2538-472: Was criticised by campaigning group Stop the NHS Sell-Off, which was supported by 38 Degrees , who said the process cost £1 million. The organisation planned to provide: The contract provides seven domains against which its outcomes will be judged: patient experience; safe care; quality care; prevention; urgent care; long term care; and end of life care. Within these there are 62 indicators. Eventually 15% of

2592-434: Was intended to tackle "deep rooted and systemic issues that previous interventions have not tackled across [a] whole health and care economy". In 2016 it organised the geographical division of England into 44 sustainability and transformation plan areas, with populations between 300,000 and 3 million. These areas were locally agreed between NHS Trusts , local authorities and clinical commissioning groups (CCGs). A leader

2646-509: Was piloted from 2015: as of April 2015, 63 were to take on fully-delegated responsibility and 87 were to begin "joint commissioning", which involved less responsibility. In 2017 it was proposed that most CCGs should take responsibility for GP contracts, as the early adopters had done well and it was "critical to local sustainability and transformation planning ". As of October they were also to be able to establish new practices, approve mergers and manage discretionary payments. In November 2014,

2700-471: Was promoted to Chief Executive on 1 August 2021. NHS England produced a planning document – the Five Year Forward View – in October 2014 which envisaged development of new models to suit local needs. In conjunction with the other central regulators, the organisation established what is called a "success regime" in south and mid Essex, North Cumbria and north east and western Devon in June 2015. It

2754-479: Was reported that NHS England were considering a special measures regime for CCGs in difficulties, of which there were said to be about a dozen. Under the assurance framework, CCGs were rated as "assured", "assured with support" or "not assured". Only Barnet CCG was rated "not assured". Guidance issued in August 2015 provided that if CCGs were in special measures for more than a year, NHS England could "trigger changes in

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2808-424: Was to be a five-year contract. Julian Huppert , MP for Cambridge, welcomed the news that the new combined services for elderly people will be run by the NHS. He said he wanted services to stay in the NHS, where the quality of health care is prioritised, as opposed to provision by private companies who have an obligation to generate a profit for their shareholders. The process of awarding the £800 million contract

2862-496: Was to commence work in April 2018 and provide full service a year later, preventing duplication of health and social care within the city. In December 2017 the ten CCGs in Greater Manchester were in various stages of establishing a "single commissioning function" with their council. Each CCG was responsible for persons who were provided with primary medical services by a member of the group, and persons who usually reside in

2916-1140: Was £1,645 for Knowsley and the lowest £1,040 for Oxfordshire. Funding per head increased in real terms by 2% a year between 2013/14 and 2018/19. In 2015, the Centre for Health and the Public Interest estimated that in 2013–14 there were about 53,000 contracts between the NHS in England and the private sector, including contracts for primary care services, of which the 211 CCGs held 15,000 with an annual value of about £9.3bn. They sent Freedom of Information requests to all 211 CCGs, seeking information about how they monitor contracts with private providers and concluded that CCGs failed to manage contracts with private providers effectively. According to Christian Mazzi, head of health at Bain & Company , in September 2015 70% of CCGs had failed to monitor their private sector contracts or enforce quality standards. 12% had not carried out any visits to private providers, and 60% could not say if they had done so. In April 2013, NHS England established 25 commissioning support units to provide

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