Centre for Primary Care, University of Manchester, Manchester, UK.
Luxembourg Institute of Health and Luxembourg Institute of Socio-Economic Research, Luxembourg, Luxembourg.
BMJ Open. 2019 Apr 1;9(4):e027622. doi: 10.1136/bmjopen-2018-027622.
Since April 2015, Clinical Commissioning Groups (CCGs) have taken on the responsibility to commission primary care services. The aim of this paper is to analyse how CCGs have responded to this new responsibility and to identify challenges and factors that facilitated or inhibited achievement of integrated care systems.
We undertook an exploratory approach, combining data from interviews and national telephone surveys, with analysis of policy documents and case studies in four CCGs. Data were analysed using thematic content analysis.
SETTING/PARTICIPANTS: We reviewed 147 CCG application documents and conducted two national telephone surveys with CCGs (n=49 and n=21). We interviewed 6 senior policymakers and 42 CCG staff who were involved in primary care co-commissioning (general practitioners and managers). We observed 74 primary care commissioning committee meetings and their subgroups (approx. 111 hours).
CCGs in our case studies focused their primary care commissioning activities on developing strategic plans, 'new' primary care initiatives, and dealing with legacy work. Many plans focused on incentivising and supporting practices to work together and provide a broad range of services. There was a clear focus on ensuring the sustainability of general practice. Our respondents expressed mixed views as to what new collaborative service models, such as the new models of care and sustainability and transformation partnerships (STPs), would mean for the future of primary care and the impact they could have on CCGs and their members.
There is a disconnect between locally based primary care and the wider system. One of the major challenges we identified is the lack of knowledge and expertise in the field of primary care at STP level. While primary care commissioning by CCGs seems to be supporting local collaborations between practices, there is some way to go before this is translated into broader integration initiatives across wider footprints.
自 2015 年 4 月以来，临床委托组（CCGs）承担了委托初级保健服务的责任。本文旨在分析 CCGs 对这一新责任的反应，并确定促进或阻碍实现综合保健系统的挑战和因素。
我们采用了一种探索性的方法，将来自访谈和全国电话调查的数据与四个 CCGs 的政策文件和案例研究进行了结合。使用主题内容分析对数据进行了分析。
设置/参与者：我们审查了 147 份 CCG 应用文件，并对 49 名和 21 名 CCG 进行了两次全国电话调查。我们采访了 6 名高级政策制定者和 42 名参与初级保健共同委托的 CCG 工作人员（全科医生和经理）。我们观察了 74 次初级保健委托委员会会议及其分组会议（约 111 小时）。
我们案例研究中的 CCGs 将其初级保健委托活动集中在制定战略计划、“新”初级保健举措以及处理遗留工作上。许多计划侧重于激励和支持实践共同合作并提供广泛的服务。明确关注确保普通实践的可持续性。我们的受访者对新的合作服务模式（如新的护理模式和可持续性和转型伙伴关系（STPs））对初级保健的未来意味着什么以及它们对 CCG 及其成员的影响持不同看法。
基于本地的初级保健与更广泛的系统之间存在脱节。我们确定的主要挑战之一是 STP 一级初级保健领域知识和专业知识的缺乏。虽然 CCGs 的初级保健委托似乎支持实践之间的本地合作，但要将其转化为更广泛的足迹范围内的更广泛的整合举措，还有很长的路要走。
