17 October 2011

Clinical Commissioning Coalition Demands Equal Relationship With National Commissioning Board

The new Clinical Commissioning Coalition, set up by the NHS Alliance and the the National Association of Primary Care, is demanding a new relationship between the National Commissioning Board and frontline clinical commissioners.

“Current proposals look too top heavy and as I speak to Clinical Commissioning Groups throughout England, too few feel that they are really being liberated,” said Dr Michael Dixon, Chairman of the NHS Alliance.  

Michael Ramsden, Chief Executive of NAPC, added: “We hear often that decisions about the NHS will come from the consulting room rather than from Whitehall and that must mean that the ‘rules of engagement’ are equally decided between clinical commissioners and the National Commissioning Board, rather than tablets of stone handed down from above.”

Dr Ken Aswani, GP in Waltham Forest, commented: "Clinical leadership is important across the system." 

The NHS Alliance/NAPC Clinical Commissioning Coalition is demanding that clinical commissioners should be represented at every level, from the National Commissioning Board to the Clinical Commissioning Groups themselves.

According to the Coalition, it is not enough for Clinical Commissioning Groups and clinical commissioning to be held at arms’ length from the National Commissioning Board communicating through its regional arms. 

The Coalition says that the same thought processes must also apply to the authorisation of Clinical Commissioning Groups, which cannot be a one way process decided by the National Commissioning Board.  The disinterested voice of clinical commissioners themselves must also be part of the authorisation process. Therefore, the Coalition is proposing that one of its representatives should sit on every panel authorising CCGs so that the centre and frontline are part of this process. 

Following Clinical Commissioning Group authorisation, annual appraisal should also be a two way process. The National Commissioning Board will need to appraise CCGs, but CCGs collectively should be able to appraise the National Commissioning Board as to whether it has been able to support and further their work and enable them to produce better health outcomes.

Dr Michael Dixon added: “If command and control is dead then 360 degree appraisal must become the norm. The future of the NHS will no longer have a ‘top’ and a ‘bottom’, but a ‘centre’ and ‘frontline’.   If the mutual hopes of commissioners at the centre and at the frontline are to be met –and that is the only way the NHS can go forward – then there needs to be a meeting of aims and aspirations. There are some very early signs that this is beginning to happen, but things must accelerate rapidly otherwise clinical commissioners will feel more shackled than liberated and the huge potential gains of enlisting frontline clinical commissioners will be lost. With it will go the hope of an every better and more sustainable NHS.”

Recently re-elected President of the NAPC, Dr James Kingsland, also stated: “This is about developing an epidemic of leadership throughout the NHS clinical community, changing behaviours at the interface between clinician and patient to enable more effective deployment of NHS resources at the point at where they are committed. This is what commissioning at scale is about – each and every one of us being involved."


  1. The NHS Alliance brings together GP consortia, PCTs, clinicians and managers as the leading organisation in primary care. We are an independent non-political membership organisation proud to be at the forefront of clinically-led commissioning. Its leaders are all dedicated professionals, who represent the Alliance’s diverse membership, working ceaselessly to meet the challenges facing the NHS today. Find out more at www.nhsalliance.org
  2. The National Association of Primary Care (NAPC) is a non-political, non-profit-making organisation representing and supporting the interests of all its members, both individuals and organisations working in or with primary care. It also offers support through associate membership to those bodies, which provide services to primary care or have other health-related interests. Find out more at www.napc.co.uk
  3. For more information, please email pressoffice@nhsalliance.orgor call 07772756674.