In a submission to a House of Commons health select committee inquiry, the think tank said local area teams’ lack of capacity to manage general practice performance could mean primary care commissioners struggle to develop relationships with practices and are forced to rely on data only, with CCGs providing intelligence on performance.
'Our work suggests widespread concern about the capacity of the local area teams more generally, particularly in relation to their role in managing general practice,' the King's Fund evidence said.
Responsibility for improving quality in general practice could be neglected where CCGs are reluctant to take on this role, it added.
It said: ‘Our research suggests that relationships between CCGs and local area teams are currently under-developed’.
The submission said NHS England’s responsibilities for commissioning primary care appeared to be ‘unchecked’, with a lack of clarity over accountability.
The select committee will begin taking evidence in its inquiry into the implementation of the Health and Social Care Act on Tuesday morning.
The King’s Fund will tell MPs that while good progress had been made establishing the new system, there was ‘significant variation’ in CCGs’ readiness to take on their roles, and that it remains concerned that fragmentation of commissioning will make large-scale service changes difficult to implement.
Monitor and NHS England also come in for criticism in the submission for failing to provide proper guidance to commissioners clarifying how competition regulations should be implemented. It said commissioners lacking procurement skills could become ‘even more risk-averse, potentially undermining efforts to deliver integrated care’.
It warned of ‘significant uncertainty about the application of competition law’.
A spokeswoman for NHS England said: 'The principles of clinically led, patient focused commissioning are as applicable to primary care services as they are in secondary care. NHS England’s role is to work hand in glove with CCGs to ensure that commissioning of primary medical services reflects local community needs and priorities.
'We know that clinical peer pressure is a powerful lever for challenging unacceptable variation and improving quality. CCGs have a statutory responsibility to support NHS England in improving the quality of primary medical care and we know that many CCGs are now taking a leading role in promoting quality improvement in their local communities.
'Since NHS England took up its commissioning responsibilities on 1 April, area teams have been actively engaging with CCGs to discuss how best to use information to highlight variations in quality and outcomes and how to work with general practice to develop more proactive, integrated services for patients.
'Supported by a national framework, we are working with CCGs to address concerns regarding quality and to develop a culture of quality improvement within practice.'