GP services for older people: a guide for care home managers

Managers' responsibilities and the NHS reforms - The NHS reforms

Commissioning primary and secondary/specialist NHS services

Under the NHS reforms, general medical services (GMS) are commissioned and held to account by NHS England through its local area teams. GP-led clinical commissioning groups (CCGs) will commission most acute, hospital and other specialist NHS services, and may contract with general practices for the provision of enhanced services for residents of care and nursing homes.

'Securing excellence in commissioning primary care' [11] sets out the new national arrangements for commissioning GP, optical, dental and pharmacy services. It explains how the local NHS England area teams will:

It also sets out the working links between the NHS England area teams and key local groups, including:

In each local authority area, one or more GP-led CCG will draw on the day-to-day experience of GPs and meet patients in their surgeries when commissioning the majority of secondary, hospital and specialist services for the local population. They will produce and publish annual commissioning plans, setting out how they propose to commission NHS services. CCGs are responsible for planning, designing and commissioning local health and care services, including:

CCG boards are made up of GPs from the local area and at least one registered nurse and one secondary care specialist doctor. In addition to the above, they are responsible for commissioning services for any unregistered patients who live in their area. Every general practice has to belong to a CCG.

CCGs are accountable to NHS England (the NHS commissioning board) at a regional level. NHS England is a new body that ensures CCGs have the capacity and capability to successfully commission services for their local population, and meet their financial responsibilities. It also has overall responsibility to ministers for ensuring the safety, quality and improvement of all aspects of NHS provision. It provides the framework of regulations and guidance within which NHS bodies must operate, and the annual NHS outcomes framework. This sits alongside the adult social care and public health outcomes frameworks, to set the strategic direction for the whole health and care system.

Joint NHS, social care, local authority and service user bodies and their functions

At local level, new joint health and wellbeing boards have been set up in local authority areas to promote joint and integrated working and ensure that CCGs meet the needs of local people. Council-led health and wellbeing boards will bring together CCGs and the adults, children and families, public health and housing leads in local councils to develop a strategic understanding of the health, social and wellbeing needs of the community. It has been suggested that health and wellbeing boards could have the power to sign off CCG commissioning plans.

Joint health and wellbeing boards are responsible for overseeing the area's joint strategic needs assessment (JSNA), which gathers and analyses all available information and views about the health, care and support needs, strengths, resources and opportunities in the area. The assessment should include current and forecast needs for residential and nursing home care and allied provision. This in turn feeds into the local joint health and wellbeing strategy, setting out health, care and housing development priorities for the area. Both the JSNA and the strategy should address the health and care needs of the ageing population, and set out how the NHS and local authorities are jointly planning, commissioning and securing provision to meet growing needs.

HealthWatch is a user and carer body, the role of which is to observe existing services from the perspective of people using them, and report back. Local HealthWatch are entitled to visit NHS and adult social care services in their area. Key to the NHS reform programme is a concerted move to involve patients and relatives more fully in the review, redesign and transformation of services. Each local HealthWatch will reflect local priorities and concerns, and will also have a link with HealthWatch England, part of the CQC, which will offer support and gather feedback to build a national picture of what local people say about local services.


All SCIE resources are free to download, however to access the following downloads you will need a free MySCIE account:

Available downloads:

  • Evidence review on partnership working between GPs, care home residents and care homes
  • GP services for older people: a guide for care home managers
  • Improving access to and experience of GP services for older people living in care homes: practice survey