An immediate priority for new NHS commissioners is to secure high-quality, sustainable outcomes, in particular reducing demand on hospital services by stimulating primary and community care and emphasising prevention and early intervention, experts have urged.

The strength of clinical commissioning groups (CCGs) is that they bring clinical and managerial experience together in one place, they say, adding: "there is significant added value in having clinical commissioners driving commissioning interventions and improved service quality at a local level."

Their comments appear in a new legacy report published by the NHS Confederation which distils lessons from more than a decade of NHS commissioning, drawn from interviews with leaders from in and around PCTs, to provide practical advice and recommendations for commissioners in the new system. The report advises them that they must:
- put community and clinical engagement "front and centre;"
- invest in establishing constructive relationships with partners; and
- be ready for rigorous, robust conversations with providers and the public about the quality and shape of local services.

CCGs are membership organisations - securing the participation of their members is critical to success, and general practices need to see themselves as part of the commissioning system, using their experience with patients to drive change, the report says. It also advises commissioners that "strong governance and transparent decision-making are key to building confidence in CCGs' work and minimising the risk of conflicts of interest."

The best guarantors of CCG autonomy will be individual success and mutual support. Collectively, CCGs need to demonstrate they can address their own problems and develop their skills without constant reference to NHS England, supporting each other and collaborating with clinical networks and services, it emphasises.

NHS chief executive Sir David Nicholson describes the report as "essential reading," and it has been endorsed by NHS Clinical Commissioners (NHSCC), the independent membership body representing CCGs, which says: "it is essential we take forward what worked, while learning the right lessons when things were not as effective as they might have been."

These points were also picked up recently by Dr Judith Smith, director of policy at health policy think tank the Nuffield Trust, who said the real lesson from the experience of PCTs is that "we have to give our organisations time to grow, to become effective, to gain stature and organisational memory. If we keep pulling the rug from under them about every four years, that is wasteful and distracting," she told a meeting organised by the Westminster Health Forum (WHF) in London.

Also speaking at the WHF meeting was Helen Northall, chief executive of Primary Care Commissioning (PCC). She praised the work of PCTs in setting up partnerships and networks with services such as pharmacies and the voluntary sector, and stressed the importance of keeping some of this "jigsaw" together as commissioners change.

She also urged commissioners to make use of the very good systems which PCTs have already put in place around medicines management and low-priority treatment review, rather than "wiping the slate clean," and told the WHF: "quality needs to be built into everything. There's a real future opportunity to increase quality by identifying issues early and getting better engagement with GPs and other primary healthcare professionals to pick up issues."