Clinical Commissioning Group Governance

This development tool is designed to support all those with responsibility for shaping the development of Clinical Commissioning Groups. The document aims to inform the debate about how to ensure the effective governance of Clinical Commissioning Groups. The research, consultation and development of
the document took place over the Autumn of 2010 and into the Spring of 2011.

Download the document here: A development tool to support emerging Clinical Commissioning
Groups with their governance arrangements

This development tool was commissioned by the National Leadership Council in July 2010 to offer an evidence-based perspective on options to support the effective governance of clinical commissioning. It was developed for the National Leadership Council by the Foresight Partnership Ltd, in partnership with NIHR King's Patient Safety and Service Quality Centre. There is likely to be considerable flexibility for Clinical Commissioning Groups to decide the approach to adopt.

The development tool has been underpinned by:

A review of governance literature, national and international, in both public and private sectors, within healthcare and beyond. This review considered 144 recent sources and was prepared to support the
development of ‘The Healthy NHS Board: Principles for Good Governance’

A supplementary literature review which looked more specifically at the governance lessons emerging from research and evaluation of previous forms of clinical commissioning. It also examined some of the available international literature on physician-led commissioning. Finally it looked for governance lessons from a range of organisational forms that may be comparable to Clinical Commissioning Groups

Interviews with GPs and policy thinkers who are currently shaping the development of clinical commissioning

The four parts of the development tool are:

The Essence of Good Governance

• A description of the proposed essence of good governance to ensure safe effective governance of clinical commissioning
• A summary of the key messages from the governance literature relevant to the essence of good governance
• Ideas to guide the process of developing robust governance arrangements, based on extensive experience in supporting governance effectiveness across public services.

This paper aims to combine respect for local autonomy and self-determination with an examination of what is known to constitute the sort of robust governance that builds public and stakeholder confidence that their healthcare, and public resources, are in safe hands.

Debating the Options

‘Debating the Options’ offers a range of governance options and questions for emerging Clinical Commissioning Groups to chew on as they develop their governance arrangements. This has also been informed by key evidence from the literature and interviews with GPs and policy thinkers.

This part develops the four key themes of strategy, accountability, culture and building effectiveness.

Debating the Options is set out as a range of questions. Readers are encouraged to explore those questions that are of particular interest. It is designed to be used as a resource to dip into while exploring
aspects of governance.

Understanding the Evidence

This development tool is evidence-based. Much of the evidence is taken from the existing review of recent governance literature produced for the development of ‘The Healthy NHS Board’. ‘Understanding the Evidence: Supporting Governance of Emerging Clinical Commissioning Groups - A Review of the Literature’ brings the evidence up to date in relation to the governance arrangements for Clinical Commissioning Groups. It has been written by the NIHR King’s Patient Safety and Service Quality Research Centre and can be located at: http://www.nhsleadership.org/images/library/files/Commissioning/Understanding_the_Evidence_Governance_Literature_Review.pdf

Learning from Case Studies

The final part consists of the learning from five case studies of practice based commissioning. These case studies are published separately, and can be located at:

http://www.nhsleadership.org/images/library/files/Commissioning/Case_studies_supporting_governance_of_clinical_commissioning_groups.pdf