Primary Care Co-Commissioning

Primary care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View.

Co-commissioning aims to support the development of integrated out-of-hospital services based around the needs of local people. It is part of a wider strategy to join up care in and out of hospital and could lead to a number of benefits for patients and the public including:

  • Improved access to primary care and wider out-of-hospitals services with more services available closer to home
  • High quality out-of-hospital care.
  • Improved health outcomes, better access to services and reduced health inequalities.
  • A better patient experience through more joined up services.

NHS England has invited Clinical Commissioning Groups (CCGs) to take on an increased role in the commissioning of GP services through three co-commissioning models:

  • Greater involvement – an invitation to CCGs to collaborate more closely with their local NHS England teams in decisions about primary care services to ensure that about healthcare services are strategically aligned across the local area.
  • Joint commissioning – enables one or more CCGs to jointly commission general practice services with NHS England through a joint committee.
  • Delegated commissioning – offers an opportunity for CCGs to assume full responsibility for the commissioning of general practice services.

In November 2014, The Next steps towards primary care co-commissioning document was published to support the local implementation of co-commissioning arrangements. This was developed by the joint CCG and NHS England primary care co-commissioning programme oversight group in partnership with NHS Clinical Commissioners.  In addition, a range of documents have been developed to support CCGs to take forward co-commissioning arrangements.

Co-commissioning: early benefits

There has been a strong response to co-commissioning and in 2015/16 nearly three quarters of CCGs have taken on an increased role in the commissioning of GP services with 63 CCGs taking on full delegated responsibility. In December 2015, a further 52 CCGs were authorised to take on delegated commissioning of GP services and will be able to operate under these arrangements from 1 April 2016. This means that over half of CCGs will have delegated responsibility in 2016/17 and we expect a third of CCGs to be operating under joint arrangements.

View the CCGs taking on greater responsibility for commissioning GP services.

During the first year of co-commissioning, we are increasingly learning that the delegated commissioning model looks most likely to deliver the greatest benefits for local people. CCGs have reported that delegated commissioning has:

  • Enabled the development of clearer, more joined up vision for primary care, which is aligned to wider CCG plans for improving health services.
  • Increased clinical leadership and public involvement in primary care commissioning, enabling more local decision making.
  • Helped to develop relationships with a wide range of local stakeholders including local GP practices.
  • Moving forward, delegated commissioning offers CCGs further opportunities to improve out-of-hospital services for local people and to support a shift in investment from the acute to primary and community settings. It will support the development of:
  • New models of care – having a single accountable provider for a defined population requires a joined up local commissioning model, where a single contract can be agreed.
  • Local incentive schemes that are aligned with CCGs’ strategic intentions.
  • Commissioning based on the best outcomes for patients.
  • Improved arrangements for GP practices to work together and changes to the organisation of community based services.

NHS England is therefore encouraging CCGs operating under the joint or ‘greater involvement’ primary care co-commissioning model to consider applying for full delegation. Further information on the co-commissioning application process is available.

The future of primary care co-commissioning

The NHS Five Year Forward View signals a clear and continued shift towards commissioning based on the specific needs of a local area and its patients. In 2016/17, NHS England will be exploring options for the possible expansion of co-commissioning into wider primary care areas, with full and proper engagement of CCGs, NHS Clinical Commissioners and the relevant professional groups. This includes community pharmacy, where scoping work will focus upon how we can strengthen partnership working between NHS England and CCG commissioners.