Executive summary
This report presents the findings from the 2015 online survey of nurses working in commissioning roles either as Governing Body nurses (GBNs) and nurses working for Commissioning Support Units (CSUs) which support CCGs. The survey was undertaken in collaboration with the Commissioning Nurse Leaders’ Network (CNLN). We present the results from the online survey in the context of current policy developments and some recommendations.
Data collection was carried out using an online survey of all commissioning nurse members of the CNLN between 11th June and 6th July 2015. All of the sample provided by NHS England (n=238) were sent a personalised email (addressed to them by name) which included an information sheet about the survey and a link to the online survey. The response rate was 40.7% (n=97) which was similar to the response rate for the survey of CCG nurses carried out in 2014 by NHS England (41%, n-=69).
Findings included in this report refer to all respondents in the survey (GBNs and nurses working in CSUs) unless otherwise indicated.
Demographic profile and previous experience
92.8% of respondents worked for one or more CCGs; 7.25% of respondents were employed by a CSU.
Respondents were mostly female, over 50 years of age, of White or White British ethnicity, with substantial clinical, managerial and Board experience.
Working patterns
75% of the respondents had worked within CCGs or CSUs for more than two years; a relatively small proportion (7.8%) had been in their post for less than one year.
79.7% of respondents worked full-time (37.5 hours a week or more) and the majority (82.2%) worked within one CCG or CSU.
Just under 18% of GBNs worked for more than one CCG and a majority of these respondents felt that all their CCGs worked well together (56.3%) but 25% said that only some are working together and 18.8% said that none were working together.
A large majority of GBNs (81%) worked in full-time statutory (executive) roles with just 14% working as part- time statutory (executive) roles.
Tensions between CSUs and CCGs.
Amongst nurses who worked in CSUs, more than half of respondents (57.2%) said that they were fairly or extremely dissatisfied with the impact of their work on the CCG (28.6% in each category). A large minority (42.9%) said that they were fairly satisfied. Comments in open-ended questions suggested that this may be explained by perceptions that CSUs are not respected or valued by CCGs or that CCGs may sometimes make unreasonable demands on CSUs.
GBNs‘ motivation, roles and experiences of working in CCGs.
The reasons for wanting to be a nurse on a CCG, which GBNs cited most frequently were: having an impact in population health; being an advocate for patient interests and ensuring a nursing influence on commissioning services.
GBNs’ perceptions of their influence of their roles on decision-making in CCGs.
GBNs were much more satisfied with their impact on CCGs (84% very or fairly satisfied) than were nurses working in CSUs. In addition, more than 90% of GBNs were extremely or fairly satisfied overall with the contribution they made to the work of the CCG.
Two-thirds of GBNs said that they chair at least one committee, most commonly the Quality Committee / Quality and Risk Committee or the Safeguarding Committee.
Over 90% of GBNs said that their CCG has an executive management board. Of these, 79.7% reported that they were a member of that board. A large majority of GBNs who were on CCG management boards (89.1%) felt that they were extremely or fairly influential on these boards.
Amongst those not on executive management boards, the reason most frequently given was that their role was not configured as an executive one and therefore they were not on the board and not able to influence decision making at this level.
A large majority of GBNs (85.1%) felt that they were extremely or fairly influential in CCG decision- making generally.
Nearly all respondents (92.7%) considered that the statutory nursing role was important (extremely or fairly) to the work of the CCG.
GBNs’ views on the perceived purpose of CCGs.
Improving the population’s heath was considered to be the most important goal of their CCG by a significant majority of respondents (61.6%); 19.2% felt commissioning was the most important goal of CCG work; 9.6% of respondents believed service redesign and meeting financial targets were the most important goals of their CCG.
GBNs’ perceptions of their ability to be leaders in CCGs.
95.8% of respondents felt that that they had a leadership role within their CCG. More than half of respondents (52.9%) said that they were ‘extremely confident’ in carrying out their leadership role and a further 38.2% were fairly confident.
Conclusions
These are positive, albeit self reported, findings regarding the nursing role in CCGs and CSUs. Some of the findings suggest causes for further investigation:
• The open- ended responses show that the influence and impact of the GBN role may in some instances be limited by certain assumptions or ways of working, particularly the perception that the GP is the lead clinician in the CCG.
• There is evidence in the findings that GBNs were much more satisfied with their impact on CCGs than were nurses working in supporting commissioning in CSUs.
Consequently, achieving the goals of the CCGs, including developing a nursing leadership role in commissioning on CCGs, may therefore be under threat if the contributions of GBNs and other nurses working for CCGS or in CSUs, go unrecognised or are under-utilised
