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Three CCGs issued with legal directions

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Three clinical commissioning groups have been legally directed by the NHS Commissioning Board because of problems detected in authorisation.

Health reporting HSJ and LGC logo

The board announced the outcomes of the second wave of CCG authorisations on Tuesday. Nineteen of the 67 tested were authorised with no conditions.

However, the board decided that for three which had a large number of conditions and more serious problems it needed to make legal directions.

The directions for each CCG vary but for each of them the board will “insert or provide [a] specific team or individual” as “support”. A spokesman for the board said this did not mean they would be ordered to take on any staff or board members. Instead, they will have to work with the board’s own staff “providing intensive support” to them.

The CCGs and main legal directions are:

  • Nene CCG, which covers most of Northamptonshire, must hand responsibility for commissioning for Kettering General Hospital Foundation Trust to nearby NHS Corby CCG. The commissioning board will oversee Nene’s contracting with Northampton General Hospital Trust and sign off its contract.
  • Medway CCG’s financial plan will be “oversee[n] and supervise[d]” by the commissioning board.
  • Herts Valleys CCG must seek the commissioning board’s approval of a new accountable officer appointment.

So far, across wave one and two CCG authorisations, the north of England region has the largest proportion of its CCGs authorised, while the south has the largest number of conditions on CCGs’ authorisation.

The largest number of conditions relate to CCGs not having “clear and credible” finance and service plans. It is understood many of these have been put in place because CCGs only received planning guidance last month, so were not able to plan in detail.

The next most common issue for conditions is CCGs’ constitutional and governance arrangements – including requirements to be demonstrate “best practice in relation to safeguarding” and “effective system of internal controls”.

Authorisation so far: Waves one and two


 Total CCGsProportion of CCGs authorisedNumber of conditions
Midlands and East6143%98


Which areas are weak? 
Authorisation domainNumber of conditions
Clear and credible finance and service plans115
Constitutional and governance arrangements73
Engagement with patients, carers and communities33
Great leaders26
Strong clinical and multi-professional focus25
Collaborative plans and commissioning support24
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