BACKGROUND:The current reorganisation of the English NHS is one of the most comprehensive ever seen. This study reports early evidence from the development of clinical commissioning groups (CCGs), a key element in the new structures. AIM:To explore the development of CCGs in the context of what is known from previous studies of GP involvement in commissioning. DESIGN AND SETTING:Case study analysis from sites chosen to provide maximum variety across a number of dimensions, from September 2011 to June 2012. METHOD:A case study analysis was conducted using eight detailed qualitative case studies supplemented by descriptive information from web surveys at two points in time. Data collection involved observation of a variety of meetings, and interviews with key participants. RESULTS:Previous research shows that clinical involvement in commissioning is most effective when GPs feel able to act autonomously. Complicated internal structures, alongside developing external accountability relationships mean that CCGs' freedom to act may be subject to considerable constraint. Effective GP engagement is also important in determining outcomes of clinical commissioning, and there are a number of outstanding issues for CCGs, including: who feels 'ownership' of the CCG; how internal communication is conceptualised and realised; and the role and remit of locality groups. Previous incarnations of GP-led commissioning have tended to focus on local and primary care services. CCGs are keen to act to improve quality in their constituent practices, using approaches that many developed under practice-based commissioning. Constrained managerial support and the need to maintain GP engagement may have an impact. CONCLUSION:CCGs are new organisations, faced with significant new responsibilities. This study provides early evidence of issues that CCGs and those responsible for CCG development may wish to address.

译文

背景:目前对英语NHS的重组是有史以来最全面的重组之一。这项研究报告了来自临床调试小组(CCG)发展的早期证据,CCG是新结构中的关键要素。
目的:在先前有关GP参与调试的研究中得知的背景下,探索CCG的发展。
设计与设置:从2011年9月至2012年6月,对在各个维度上提供最大多样性的站点进行案例研究分析。
方法:使用八个详细的定性案例研究进行案例分析,并在两个时间点从网络调查中获得描述性信息。数据收集涉及对各种会议的观察以及对主要参与者的采访。
结果:先前的研究表明,当GP能够自主行动时,临床参与调试是最有效的。复杂的内部结构以及不断发展的外部问责关系意味着CCG的行动自由可能受到相当大的限制。有效的全科医生参与对于确定临床调试的结果也很重要,对于CCG而言,存在许多悬而未决的问题,包括:谁感觉到CCG的“所有权”;内部沟通如何被概念化和实现;以及地方团体的作用和职权范围。以前由GP领导的投身方式倾向于集中在本地和初级保健服务上。 CCG热衷于采取行动,使用许多基于实践的委托开发的方法来提高其组成实践的质量。有限的管理支持和维持GP参与的需求可能会产生影响。
结论:CCG是新的组织,面临着重大的新职责。这项研究提供了CCG和CCG开发负责人可能希望解决的问题的早期证据。

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