All of England’s 212 CCGs must have a constitution in place before they can become authorised. According to the NHS Commissioning Board (NHSCB), constitutions should outline the CCG’s functions, its decision making processes, how it manages conflicts of interest and explain how it relates to member practices.

But GPC negotiator Dr Chaand Nagpaul has called upon the NHSCB to make public its rules on how many member practices need to sign a CCG constitution before it can be authorised.

He said: ‘One of they key components of authorisation is for there to be demonstrable sign-up of practices, that is the NHSCB’s requirement. We don’t have clarity as to how the NHSCB will gauge sufficient sign-up of practices because what we are seeing is constitutions not being signed by all member practices, in some cases a minority and in some cases not signed up in any significant numbers. And yet these applications are going to the NHSCB for authorisation.’

GPC deputy chairman Dr Richard Vautrey said there are still concerns and confusion among practices about constitutions and that the vast majority of CCGs are using the NHSCB’s 101-page template.

He said: ‘They are embellishing it and it means there are documents well over 100 pages. Many GPs and practices are still reporting being presented with constitutions for which they have had little input. They are being asked to sign it without enough time to be able to consider what is in it.

‘We remain concerned about the speed of this process. We want to encourage every practice and as many GPs as possible to look carefully at their constitution before signing up to them and raise any concerns with the LMC or the CCG. Do not accept as default the constitution they have been presented with if they are not happy.’

A NHSCB spokeswoman said: ‘The NHSCB guidance is clear that CCGs must demonstrate formal evidence of agreement by constituent practices of their proposed constitution. This can be achieved in a variety of ways according to the CCGs’ preference, for example by signatures on the constitution document itself or through letters of support.

‘As detailed in the NHSCB’s applicant guide, the authorisation process triangulates evidence of constituent practices’ engagement, using a variety of methods including the 360-degree stakeholder survey and requirement for first-hand examples of practices’ involvement in decision-making.’