Governing body nurses' experiences of clinical commissioning groups: an observational study of two clinical commissioning groups (CCGs) in England

Clinical commissioning groups (CCGs) were set up under the Health & Social Care Act (2012) in England to commission healthcare services for local communities. Governing body nurses (GBNs) provide nursing leadership to commissioning services on CCGs. Little is known about how nurses function on clinical commissioning groups. We conducted observations of seven formal meetings, three informal observation sessions, and seven interviews from January 2015 to July 2015 in two CCGs in the South of England. Implicit in the GBN role is the enduring and contested assumption that nurses embody the values of caring, perception and compassion. This assumption undermines the authority of nurses in multidisciplinary teams where authority is traditionally clinically based. Emerging roles within CCGs are not based on clinical expertise but on well-established new public management concepts which promote governance over clinically based authority. While GBNS claim an authority located in clinical and managerial expertise, this is contested by members of the CCG and external stakeholders irrespective of whether it is aligned with clinical knowledge and practice or with new forms of management, as both disregard the type of expertise nurses in commissioning embody. Key words: case study; clinical commissioning groups; governing body nurses; leadership; authority; observation