1. Engaging with Clinical Commissioning Groups (CCGs)
Welcome slide
Compact Voice
July 2015

2. What is a Clinical Commissioning Group?
Created by the Health and Social Care Act 2012
Responsible for commissioning the majority of health services in England – approx. 80% of the healthcare budget / £66 billion in 2015/16
Aim to promote a more joined up and integrated approach to the commissioning and delivery of services
CCGs are one of the new bodies created by the Health and Social Care Act 2012 which transformed the way in which health services are commissioned.
Operational since April 2013, CCGs are responsible for commissioning the majority of health services in England, amounting to approximately 80% of the healthcare budget or around £66 billion in 2015/16. This includes hospital care, community health services, rehabilitation services, mental health services and other forms of care.
CCGs aim to reduce silo working between health and care providers by promoting a more joined up and integrated approach to the commissioning and delivery of services. CCGs and the organisations that they commission support services from – especially commissioning support units (CSUs) – are therefore vital partners for the voluntary sector.

3. What is the CCGs role? Duties when exercising functions include:
Reduce inequalities
Promote patient involvement
Provide patient choice
Promote innovation
Promote the integration of health services
Consult patients and the public at various specified stages of the commissioning process
CCGs have a number of duties which they must take into account when exercising their commissioning function. These include improving services, reducing inequalities, promoting patient involvement, providing patient choice, promoting innovation and promoting the integration of health services.
Importantly, CCGs also have a duty to consult patients and the public at various specified stages of the commissioning process, including when creating commissioning plans, developing and considering proposals for change and making decisions affecting the operation of commissioning.

4. Where are they? 211 CCGs in England
Each CCG typically covers between 150,000 and 300,000 patients each
Do not align with local authority boundaries
Interactive map available at: rces/ccg-maps/
This map is illustrative and is included to help you gain an insight into the number of CCGs and where they are located. Further information on CCGs can be found on the NHS England website.
There are currently 211 CCGs in England. Typically, each CCG will cover between 150,000 and 300,000 patients, but some larger CCGs cover a population of over half a million.
CCGs do not align with local authority boundaries. It is possible, therefore, that there will be several CCGs within each local authority area, and some that cross area and county boundaries.
A searchable interactive map showing each CCG boundary is available via the NHS England website.

5. Structure of a CCG Common features:
Governing body to make key decisions
All GP surgeries must be members of a CCG
Locality structures which co-ordinate a group of practices within their area and report back to the CCG governing body
Executive teams manage the day to day activities of the CCG
CCGs have a significant amount of control over their governance arrangements and so there is a degree of local variation. They do, however, share some common features.
CCGs are required to have a governing body which is responsible for the CCG’s key decisions. The governing body is chaired by an elected GP, and includes representatives from other GP members, members of the executive team, a hospital doctor, a nurse, lay members and representatives from other local partners. Some members will concentrate on a specific area of the CCG’s work, in particular, one of the lay members will have specific responsibility for patient and public participation. Lay members may be drawn from the voluntary sector.
All GP surgeries are required to be members of a CCG. Most CCGs will have a member council; the exact function of these varies, but they generally represent the membership and liaise with the governing body and executive team. Member councils may also agree the vision and values of the CCG, approve the commissioning plans and any changes to the constitution.
Most CCGs, especially larger ones, will have locality structures covering geographical areas within the CCG boundary. This system allows the CCG to operate as a true membership organisation, and builds upon the engagement with each individual practice. Locality structures co-ordinate a group of practices within their area and report back to the CCG governing body. In some areas, localities may have a significant degree of autonomy including a commissioning budget and flexibility to keep any surplus to re-invest in locally.
The executive team manages the day to day activities of the CCG. The size of the team will vary according to which activities have been outsourced and which have been kept within the CCG.
Photo courtesy of Keith Williamson via

6. How CCGs fit into the commissioning landscape (1)
Health and wellbeing boards
agree strategic priorities
ensure commissioned services meet local needs
statutory duty to encourage the integrated delivery of health and social care
some have voluntary sector representation
Healthwatch is the consumer champion in health and care
To understand how CCGs operate, it is important to be familiar with the other key bodies in the health commissioning landscape.
The 130 health and wellbeing boards (HWBs) in England were established in 2013 to bring together relevant statutory agencies to agree strategic priorities and ensure commissioned services meet local needs. Each top tier and unitary Local Authority has its own HWB Board.
The local HWB is responsible for producing the joint strategic needs assessment (JSNA), which identifies the current and future health and social care needs of the local population. They then produce the joint health and wellbeing strategy (JHWS), which is a plan for meeting the needs identified in the JSNA.
HWBs have a statutory duty to encourage the integrated delivery of health and social care to advance the health and wellbeing of people in their area. Although they do not commission health or care services they are important bodies for voluntary sector organisations to engage with.
A HWB must have a minimum membership of a local elected council member, the director of public health for the local authority and representatives of the local Healthwatch organisation, local CCG, director for adult social services, director for children's services and director of public health. While there is no statutory requirement for the voluntary sector to have a place on the HWB, some HWBs have a voluntary sector place, usually set aside for the local CVS or voluntary action organisation.
Healthwatch England is the national consumer champion in health and care. It is responsible for engaging with users of health and social care services and has significant statutory powers to ensure the voice of the consumer is strengthened and heard by those who commission, deliver and regulate health and care services. and ensuring their views are heard.
Local Healthwatch across England provide unique insight into people’s experiences of health and social care issues across the country, feeding back to Healthwatch England on what matters to their local communities. Local Healthwatch has a role in representing the voluntary sector where the sector does not have its own place on a HWB. The geography and number of Local Healthwatch organisations mirrors that of local authorities.
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7. How CCGs fit into the commissioning landscape (2)
Commissioning Support Units provide support for CCGs
NHS England oversees CCGs and commissions certain services
Public Health England provides support to local authorities and the NHS
Strategic clinical networks ensure a strategic approach to care quality in priority areas
Clinical Senates provide strategic advice to commissioners
CCGs are generally much smaller than their predecessors, primary care trusts (PCTs), and therefore many outsource support services. The biggest providers of such support are Commissioning Support Units (CSUs). Most CSUs have retained some of the personnel and experience from PCTs and offer local and practical commissioning support such as procurement, contract management, business intelligence, service redesign, communications and public and patient engagement, the latter being particularly relevant to the voluntary sector.
NHS England is the national body responsible for overseeing the commissioning of health services by CCGs. NHS England also commissions certain services directly, including primary care.
Public Health England is the executive agency providing expertise and information to public health teams in local authorities and the NHS.
Strategic clinical networks are networks of commissioners, patients and providers which ensure a strategic approach to improving the quality of care in priority areas.
And lastly, Clinical senates are comprised of a steering group and broader forum of experts to provide strategic advice to commissioners in their local area.

8. Engaging with CCGs (1)
Have a clear idea of how the CCG is set up in your local area and whether they are the appropriate body to engage with
Highlight the strengths of the VCS:
Expertise
Social value
Innovation
Early action and prevention
Close connection to marginalised groups
Provide a coherent front
It is important that you do your homework and have a clear idea of what CCGs do, how the it is set up in your local area and whether it is really the CCG that you want to engage with. For example, consider why you are approaching the CCG, and not the HWB, the CSU, or the local authority.
Collecting this information will give you a better idea of how the CCG actually operates, where the influence lies and who is already engaging with the CCG. Although the governing body is responsible for the key decisions of the CCG, it may be that important discussions are held elsewhere, for example, in a sub-committee or within a locality structure.
NHS England’s Five Year Forward View emphasises stronger partnerships between the NHS and voluntary organisations. However, for CCGs who have limited previous experience of the voluntary sector or preconceived ideas about how it operates, it is important to be able to make a concise and strong case about the value and strengths of the sector. This includes:
Voluntary sector organisations are often experts in their chosen field or work. By working with geographic or thematic communities, often over the course of many years, voluntary sector organisations have detailed knowledge of local health and social issues.
The ultimate goal of the voluntary sector is to meet the needs of its beneficiaries, so it will often deliver additional value over and above that of the core work aims of the service.
The voluntary sector can be innovative. VCS organisations can often identify problems and experiment with different solutions more rapidly than the statutory or private sector, particularly when they are grant funded.
The voluntary sector excels in early intervention, prevention and holistic services which reduce the need for individuals to rely on statutory services later on.
The sector has contact with underrepresented groups. The voluntary sector organisations reach people who are less likely to be heard by government, ensuring that policies take into account the needs of all sections of society.
Whether it is through the local CVS (in some areas, infrastructure organisations are negotiating funding from CCGs to perform the co-ordinating function) or another route, it is important that the voluntary sector is able to provide a coherent front.

9. Engaging with CCGs (2) Help solve a problem the CCG cares about
Provide evidence of the voluntary sector’s value
Encourage the CCG to sign up to their local Compact
It is important to be able to show that your work can help solve a problem that the CCG cares about. Providing real-world evidence of the voluntary sector’s impact is a particularly powerful way to make a positive case for why they should engage with the voluntary sector.
For example, CCGs, HWBs and LAs are all partners to a local Better Care Fund, which creates a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their well-being as the focus of health and care services. This can often only be achieved by working across organisational boundaries to deliver the outcomes that matter to service users. This can provide opportunities for the voluntary organisations who are ideally placed to identify user need and experts at delivering holistic interventions that go beyond narrow service silos.
Local Compact working groups should also be actively engaging with CCGs, encouraging them to sign up to, and get involved in, their local Compact. Signing up sends out a strong signal that CCGs are committed to working in partnership with local voluntary and community organisations for the benefit of local communities. More importantly, signing up to a local Compact can provide a key way for CCGs to access individuals who are difficult to reach and whose health and wellbeing needs can often be overlooked.
CCGs are increasingly recognising the value of being a signatory to the local Compact. The 2014 Compact Survey reported twice as many local Compacts counted a Clinical Commissioning Group as amongst their signatories as they did in 2013.

10. Case study: Bristol
CCG provided support to smaller voluntary organisations who struggled to bid to provide services
VCS provided assistance through briefings, networking events and support surgeries
11 voluntary organisations are in collaborations which hold Modernising Mental Health contracts with the CCG
As part of its Modernising Mental Health commissioning process, Bristol CCG decided to provide extra support to smaller voluntary organisations who often struggle when bidding to provide services.
The two voluntary sector organisations commissioned to deliver this support surveyed the sector to understand where the gaps were, and provided assistance through briefings, networking events and support surgeries to address these issues. The CCG also provided grants for specific support for bid-writing.
A number of voluntary organisations took advantage of the support offered, and 11 are now involved in collaborations which now hold Modernising Mental Health contracts with the CCG.
Bristol CCG was shortlisted in the Innovation category at the 2014 Compact Awards for this work.

11. Case study: Stockton grant funding project
Health Improvements Initiative project jointly funded by Hartlepool and Stockton-on-Tees CCG and Stockton Borough Council
Charity Catalyst Stockton managed the grant funding
27 bids were submitted and 14 organisations were successful in securing funding
The 2014 Health Improvements Initiative is a project jointly funded by Hartlepool and Stockton-on-Tees CCG and Stockton Borough Council.
Recognising the value of local voluntary sector organisations working on health initiatives, a total of £500,000 was made available in grant funding.
While the commissioners set expectations and were part of the decision making process, the local voluntary sector support organisation, Catalyst Stockton, managed the grant funding. 27 bids were submitted and 14 organisations were successful in securing funding.

12. How the Compact can help (1)
The Compact establishes a way of working for the benefit of all parties leading to:
Independence and the right to campaign
Consulting with charities when developing policies
Supporting charities to deliver projects and services
Understanding the impact of changes to funding and other forms of support
Protecting and considering disadvantaged groups
A local compact establishes an agreed approach to partnership working between voluntary and community sector organisations and local public sector bodies for the mutual benefit of both.
Specific commitments and undertakings from both the public and VCS sectors help to focus on five key outcomes. These are:
A strong, diverse and independent civil society with the right to campaign.
Effective and transparent design and development of policies, programmes and public services which includes consulting with the voluntary sector when designing and delivering policies.
Responsive and high-quality programmes and services.
Clear arrangements for managing changes to programmes and services which should include a dispute resolution process.
An equal and fair society which protects and considers the needs of minority and disadvantaged groups.

13. How the Compact can help (2)
Encourage CCG to:
Provide high quality information accessible
Publish and adhere to a commissioning and procurement plan which embeds social value
provide grants where possible
CCG to give regularly updates of ongoing budget discussions
Work with the CCG to map the diversity of the local voluntary sector
The Compact outcomes are more than abstract concepts, they are concrete steps which can help ensure that the voluntary sector is not an optional extra, but both a co-producer and provider and an advocate for real change to health and care commissioning.
For example, Principle 1.4 of the Compact aims to ensure greater transparency by making data and information more accessible. Translated into action, this means encouraging your CCG to produce high quality agendas for meetings, with graphic overviews, summaries and highlighting significant risks, issues and exceptions.
Principle 2.2 seeks to ensure that the social impact that may result from policy and programme development is fully considered. In taking this forward, you should ask your CCG to publish and adhere to a commissioning and procurement plan which embeds social value.
Principle 3.2 encourages CCGs to consider a wide range of ways to fund or resource civil society organisations. This includes encouraging the CCG to give grants as well as contracts and remind them why it might be advantageous to do so.
The goal of principle 4.3 is to ensure that where there are restrictions or changes to future resources, the implications are discussed with voluntary organisations as soon as possible. This includes asking the CCG to give regularly updates (through a sector representative or forum) of ongoing budget discussions.
Principle 5.2 acknowledges that organisations representing specific disadvantaged or underrepresented groups can help promote social and community cohesion. To help achieve this objective you should work with the CCG to map the diversity of the local voluntary sector and show how links with specific organisations could help reach a wide range of ‘under the radar’ people and groups.

14. Further Information
‘Practical Guide to engaging with Clinical Commissioning Groups’ and ‘Practical Guide to engaging with health and wellbeing boards’ s/briefings-and-guidance
Compact Voice for advice and support: or visit the website
Further information is available on the Compact Voice website.
“The Practical Guide to engaging with Clinical Commissioning Groups” provides hands-on steps for voluntary organisations to follow to develop relationships with Clinical Commissioning Groups.
It has been produced by Compact Voice in partnership with Regional Voices.
In addition, Compact Voice has produced in partnership with Regional Voices the “Practical Guide for Voluntary Organisations to Engaging with Health and Wellbeing Boards”. It provides useful steps to follow to develop relationships with Health and Wellbeing Boards.
The information contained in both guides is based on the experiences of organisations who have established strong links with CCGs and HWBs in their areas.
Photo courtesy of Mark Morgan via