Over 60% of commissioning groups to be led by former PCT staff

Most clinical commissioning groups (CCGs) are set to make a manager their accountable officer, and are choosing primary care trust staff to fill key leadership roles in their organisation.

LGC’s sister title Health Service Journal obtained data on the individuals being picked to take on accountable officer, chair and chief operating officer roles in CCGs. The organisations will take over most of the NHS budget from April next year.

The accountable officer will be responsible for each CCG’s duties, functions, finance and governance.

Of the 81 CCGs that have identified their preferred accountable officer and responded to HSJ, 50 chose someone with a managerial background - 62% of the total.

HSJ understands that figures collected by strategic health authorities echo that finding.

Speaking in November, health secretary Andrew Lansley urged clinicians to take on the roles and said: “The whole point of clinical commissioning is to put clinicians at the heart of commissioning.”

CCGs’ chief operating officers are their most senior managers. In some areas the post is referred to as chief executive or managing director. Where the accountable officer is not a GP, the chief operating officer almost always also fills that role.

Many CCGs have shadow chief operating officers in place and HSJ analysed information for 152 CCGs. A large majority are PCT staff. Just 7.6% were previously employed by practice based commissioning groups and 2.3% by GP practices or providers.

HSJ has information about the chairs of 219 emerging CCGs. The vast majority are GPs (see breakdown, bottom of the page).

A significant majority have held senior posts either as advisors to PCTs or in practice based commissioning groups.

North East Lincolnshire CCG shadow accountable officer Peter Melton, a GP, said clinicians had a better chance of success in the role. For example, he said they would be more able to ensure the organisation was clinically focused, and resist external pressure and demands.

“As an accountable officer [GPs] are in a better position to influence the tactical priorities [of the CCG] and ensure you are delivering against those,” he said. “You are also more able to resist top-down pressures.”

He added: “If you are a visible community leader who has clinical credentials it is also easier to deliver the [support of the] GP workforce and community.”

Matt Walsh, who has been nominated as accountable officer for Calderdale CCG, worked for 20 years as a GP and left practice last year to become West Yorkshire PCT cluster medical director.

He said CCGs should appoint accountable officers who were capable rather than opting for clinicians who were unprepared, which could be a “recipe for trouble”.

Sheffield CCG shadow chief operating officer Ian Atkinson, previously the PCT’s interim chief executive and performance director, said CCGs required a strong managerial lead with the time, ability and experience needed to handle external demands.

However, he said it required a “fundamentally quite different type of management” from that in PCTs. He said GPs needed to “drive [the] vision, innovation, quality and planning” in the organisation.

NHS Commissioning Board national director of commissioning development Dame Barbara Hakin said: “We want to encourage as many [clinical] accountable officers as want to do it and put in support to help them. [But] that is by no means the only model that will work.”

She said emerging CCGs had strong clinical leaders in place but in many cases needed to develop successors.

“A lot of commissioning groups have raised this. [Their leaders] say they are happy to do it for a couple of years, but they need to make sure they bring someone through to take it on.”

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