The hard work, commitment and stamina of Clinical Commissioning Group (CCG) leaders for those CCGs seeking authorisation in Wave 1 of the process has now paid off. On 10 December 2012, it was announced that all 34 organisations in this first wave have been authorised, meaning they are ready to take up their statutory duties from 1 April 2013.

The NHS Commissioning Board (NCB), the authorising body, described the result as "an historic moment for the NHS in England". Indeed, it marks a genuine break with the centralised, top-down approach to commissioning and buying healthcare services which until now had been virtually hard-wired into the NHS.

Final score: The Wave 1 results

Eight of the 34 CCGs in Wave 1 met all the authorisation criteria: Bassetlaw, Great Yarmouth and Waveney, Kingston, Leicester City, Oldham, Somerset, Warrington and West Cheshire.

The remaining 26 CCGs have a range of conditions attached to their authorisation; some have as few as one or two conditions, while others have more than five. The NCB views these as "minor".

The conditions relate to the six authorisation domains which, in brief, are:

  • Domain one: a strong clinical and multi-professional focus.
  • Domain two: meaningful engagement with patients, carers and their communities.
  • Domain three: clear and credible plans which deliver the NHS's quality, innovation, productivity and prevention (QIPP) challenge.
  • Domain four: proper constitutional and governance arrangements.
  • Domain five: collaborative arrangements for commissioning.
  • Domain six: great leaders who individually and collectively make a real difference.

Unsurprisingly, most conditions apply to domain three. By their nature, CCGs are led by clinicians and many of these individuals are only now getting to grips with the financial aspects of commissioning, particularly the exigencies of meeting the QIPP challenge. Even so, domains one and four have also attracted significant numbers of conditions.

Next steps

The NCB has identified a range of support options to help CCGs clear these conditions - the main ones being the provision of expert support, model documents and toolkits. None of the CCGs are losing control of their statutory functions, which is another possible support option that the NCB could apply.

With authorisation mostly behind them, the Wave 1 CCGs can now concentrate on their core function: commissioning. Many are now finalising their arrangements with the commissioning support units, and thinking about how they can work together with other CCGs and local authorities to put their stamp on local services.

For the remaining Wave 2, 3 and 4 CCGs (78 in all), the authorisation process continues. The results for these waves will be announced in January (67 CCGs), February (63 CCGs) and March 2013 (47 CCGs).