Decision-making in English Clinical Commissioning groups: A mixed methods study

My research primarily investigated the Clinical Commissioning Groups (CCGs) in the English National Health Service (NHS) to identify factors influencing effective decision-making as perceived by General Practitioners (GPs) with formal roles in CCGs. A study by the British Medical Association (BMA) (2014) revealed that GPs at practice level felt that CCGs were developing policies that restrict efficient delivery of health care. As such, I developed a hypothesised conceptual model demonstrating factors at play in the decision-making process, which I tested using Partial Least Squares Structural Equation Modelling (PLS-SEM). Alongside, informed by the conceptual model, was the qualitative strand, with the data that I analysed under interpretative phenomenological analysis (IPA). Quantitative and qualitative data were collected simultaneously through a survey using a questionnaire in a convergent parallel mixed methods design, underpinned by a philosophical position of pragmatism. Data was collected in 2017. Usable responses comprised of 73 GPs in England. The study results, which contribute to theory and practice, discovered that; for practice, autonomy only was not enough to ensure efficiency of the CCGs. Other aspects like Finance and GP Proportion came to the fore. For example, many concerns about CCG policies perceived as adverse were attributed to Finance, while GP Proportion was found to have a significant effect on the perceived decision-making process effectiveness. For theory, the intention behind the setting up of the CCGs, to move, effectively, from a bureaucratic model of organisational structure to a professional model (Mintzberg 1979) was found to be threatened.