15 October 2013

Dr Michael Dixon: CCGs Must Control Primary as well as Secondary Care Budget if the NHS is to be Sustainable

In a speech at the Westminster Health Forum today, Dr Michael Dixon, chairman of the NHS Alliance and president of NHS Clinical Commissioners, will outline his vision for the future of the NHS, highlighting the need for CCGs to control the primary as well as secondary care budget.

Focusing on financial sustainability, Dr Dixon will say that the future of the NHS depends on a collective determination to create a primary care led NHS that uses secondary care expertise and technology only when necessary and appropriate, rather than the centralised secondary care led NHS that currently exists.

Acknowledging the progress of clinical commissioning, Dr Dixon will highlight two significant threats to its success: the uncompetitive ‘payment by results’ approach to funding secondary care, and the splitting of primary and secondary care budgets between NHS England and CCGs.

For clinical commissioners to have the headroom to redesign and extend health services in the radical way they have been asked, the speech will argue that they must control the entirety of the primary and secondary budgets. In this completely decentralized vision for the NHS, CCGs would hold GP and specialist contracts, allowing more community work and a new era of integrated services.

The biggest hurdle, Dr Dixon will say, “is the lunacy of expecting Clinical Commissioning Groups to redesign care and extend the ability of community services and general practice to look after patients closer to home, while separating the budget for primary care – which goes to NHS England – from that for commissioning community and hospital services – which goes to CCGs”.


NHS Alliance provides a strong, authoritative, independent voice for NHS primary care users and providers. It brings together patients, frontline staff, providers and commissioners bound by the common values of the NHS. Its core purpose is to work collaboratively to improve health care within a sustainable NHS, facilitating new and better ways of delivering services through its networks and campaigns. It welcomes patient-focused organisations and individuals of all disciplines, representing them to government and its agencies to influence policy in the interests of all its members.

In 2012 NHS Alliance achieved a long term aim: to see commissioning handed to clinicians. Strategic health authorities and primary care trusts are now giving way to new clinical commissioning groups (CCGs) led by GPs, with responsibility for commissioning £60bn worth of services on behalf of their populations.

NHS Clinical Commissioners (NHSCC) is a joint initiative from the NAPC, NHS Alliance and the NHS Confederation. Its membership service provides clinical commissioning groups (CCGs) with a single, strong and independent collective voice.