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The creation of clinical commissioning groups (CCGs) is at the heart of the government's reforms to health and social care in England. On 1 April 2013, these newly formed, clinically led groups were handed control of around two-thirds of the English NHS budget, and responsibility for commissioning secondary and community care services for their local population. Much attention has been given to their commissioning role, but CCGs have another distinct role to play in supporting quality improvement in general practice. CCGs are in the unique position of being membership organisations, which presents an opportunity for GPs to be more closely involved in transforming primary care.

Will CCGs be able to influence changes needed in primary care when they do not oversee the NHS contracts for primary care? Success here will be dependent on strong engagement with GP members.

The King's Fund and The Nuffield Trust have been working together to study six CCG case study sites, focusing on governance processes and structures as well as emerging relationships. A distinctive feature of CCGs is that they harness the clinical expertise of their GP members. Our research explores how this is being done in practice - how members are involved in their CCGs, what influence they have over commissioning decisions and how leaders and members are working together to develop primary care locally. Findings from the first year of the research reveal the opportunities that CCGs have and challenges they face.

Our research suggests a great deal of enthusiasm at grassroots level, with GPs generally wanting CCGs to succeed, and a lot of energy and enthusiasm among leaders. CCGs have brought local clinicians together, in many cases formalising and building on collaborations between practices that existed more loosely under practice-based commissioning; but in other cases through the creation of new networks and relationships. We heard from GPs who felt positive about being in it together.

More than two-fifths of general practice respondents to our survey felt they could influence the work of their CCG - far higher than the number who thought they could have influenced primary care trusts (PCT) in the past system. Interviews suggested that the GP voice is better represented in CCGs than it was in PCTs.

Importantly, the majority of GPs believed that CCGs have a legitimate role in influencing their members in terms of referrals, prescribing, and other issues - although some felt wary about the form that this involvement could take. There was concern that the financial environment that the NHS is facing, with significant savings needed over the coming years, may lead to CCGs performing a rationing function that could damage GP-patient relationships.

Reconciling this role with the need to maintain clinical engagement and member ownership will therefore be a delicate balance for CCG leaders to strike. Most CCGs are emphasising their intention to take a supportive approach, particularly through provision of comparative performance data to member practices, and by facilitating various forms of peer-to-peer dialogue.

Our survey also highlighted that engagement - awareness, support and involvement - among CCG members is not universal. Nearly half of our survey respondents without a formal role in the CCG feel disengaged in its work - lack of time and capacity being the most frequently cited reasons. CCG members are also less likely than leaders to believe the CCG is owned by its members. Low GP engagement was a major barrier to the success of previous models of clinical commissioning. It is therefore critical that CCGs continue and build momentum on engaging GP members. Driving service changes that will win the support of the clinical community may be important here.

Over the next two years, our case study sites will shed further light on whether and how CCGs are building on the enthusiasm at grassroots level and harnessing the support of their GP members in order to develop and change primary care.

Shilpa Ross is a researcher for the This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers. and Dr Louise Marshall is specialty registrar of public health for the Nuffield Trust