CCGs adopting 'worst of PCT habits', warns GPC

Clinical commissioning groups (CCGs) are excluding LMCs from the development of their constitutions and risk morphing into 'the worst of PCTs', GP leaders have warned.

Dr Buckman: 'Because of our guidance some practices and GPs are saying "we’ll have a think about this" and this document is part of that empowering process.’
Dr Buckman: 'Because of our guidance some practices and GPs are saying "we’ll have a think about this" and this document is part of that empowering process.’

GPC members backed a motion on Thursday calling for CCGs to sign up to seven key principles in a 'fair commissioning charter'. GPC chairman Dr Laurence Buckman said the advice would empower GPs and practices to say 'no' to constitutions that impose unnecessary conditions.

The GPC said the seven principles (see below) were not meant to be prescriptive and could change after feedback from CCGs and LMCs.

GP revealed last year that GP leaders were warning practices not to sign 'draconian' legal agreements imposed by CCGs.

GPC deputy chairman Dr Richard Vautrey said some constitutions are still placing unnecessary obligations on practices. He said: ‘Practices have to be in CCG. That is as far as it goes. There is no further obligation for practices to do anything.

‘We have had reports about unhelpful constitutions being proposed, that would if a practice signs up to them put them under significant burden and expectations that would take them beyond the relationship they have with their PCT. Clearly we want practices and GPs to be fully engaged with their CCG.

‘What we don’t want is some CCGs to emulate the worst of some PCTs, where decisions were made remotely without any involvement of clinicians and then imposed top-down onto practices and clinicians in a draconian way preventing them from prescribing in a particular way, preventing them from referring in a particular way.’

GPC negotiator Dr Chaand Nagpaul said: 'We believe that LMCs should be central to enabling fair constitutions that allow two-way accountability. The constitution is not something to be presented to practices as a fait accompli.’

Dr Buckman said he hoped the guidance would empower practices and GPs. He added: ‘We are encouraged to hear examples of GPs feeling empowered to say 'no' when PCTs are thrown into rapid clustering against their will and are making decisions to do with commissioning support with 48 hours' notice saying "you have to decide this or else". Because of our guidance some practices and GPs are saying "we’ll have a think about this" and this document is part of that empowering process.’

The seven fair commissioning charter points are:

  • Work to improve the quality of and access to local health services and reduce health inequalities.
  • Develop a culture of genuinely clinician-led commissioning, taking decisions in the best interests of the local population.
  • Engage with patients and the public with respect to decisions taken about their health services.
  • Operate in a transparent and open manner, and in the interests of transparency, not engage in any contracts or negotiations which impose conditions of commercial confidentiality; in the further interests of transparency will take decisions in public unless to hold them in private for legal reasons.
  • Resist any qualified provider (AQP) being imposed from sources outwith CCG.
  • Always take decisions in the light of the likely effect on the important relationship between individual GPs and their patients.
  • Establish and strengthen working relationships with LMCs, further enabling successful outcomes in commissioning.


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