title: Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS.
abstract: Objectives To explore the 'added value' that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP 'added value' in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the 'added value' that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services.
authors.affiliation: 1 Research Fellow, Centre for Primary Care, University of Manchester, UK.
authors.forename: Imelda
authors.initials: I
authors.lastname: McDermott
authors.affiliation: 2 Professor of Health Policy & Primary Care, Centre for Primary Care, University of Manchester, UK.
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
authors.affiliation: 1 Research Fellow, Centre for Primary Care, University of Manchester, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Coleman
authors.affiliation: 3 Research Fellow, London School of Hygiene and Tropical Medicine, UK.
authors.forename: Dorota
authors.initials: D
authors.lastname: Osipovič
authors.affiliation: 3 Research Fellow, London School of Hygiene and Tropical Medicine, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Petsoulas
authors.affiliation: 4 Research Associate, Centre for Primary Care, University of Manchester, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Perkins
mesh_terms: D058005:General Practitioners / Q000458:organization & administration*; D006285:Health Planning / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
keywords: GP added value; GP commissioning; NHS; primary care organisation; primary care purchasing; realist evaluation