BMA publishes authorisation guidance for CCGs

The BMA has made a number of recommendations and highlighted its concerns over government plans for the future of clinical commissioning groups (CCGs) as they approach authorisation.

The BMA guidance on the authorisation process for CCGs provides CCGs with advice on each of the six key domains that they will be judged on, and outlines what evidence they will be required to submit.

One of the key domains requires CCGs to ‘support’ the NHS Commissioning Board (NCB) in its role as commissioner of primary care.

CCG's key role
The guidance argues that although CCGs have a key role to play in local standard setting, they should not be expected to hold practice contracts – it should be the role of the NCB.

‘CCGs should have no role in performance management of the practice contract, to avoid conflict of interest and to ensure a consistent approach to contract management across primary care,’ the guidance said.

The guidance stressed that in order for CCGs to succeed, engagement with constituent practices will be ‘absolutely vital’.

LMCs will play a ‘crucial role’ in opening up conversations between CCGs and practices, as well as facilitating CCG elections and mediating any conflicts, the guidance said.

According to the guidance, the government has recommended that secondary care clinicians should also be involved with CCGs through clinical networks and clinical senates.

However the BMA expressed its concern that these bodies ‘risk cultivating bureaucracy and hindering not helping the work of the CCG’.

The guidance recommends that these bodies should be linked to CCGs not the NCB, to ensure they ‘constructively contribute to the commissioning process and encourage integration’.

CCGs must also show how they will ensure inclusion of patients, carers, public, communities of interest and geography, health and wellbeing boards and local authorities, the guidance said.

As part of this requirement, GPs will need to engage more with patients outside of the consultation room, however the doctor-patient relationship must not be affected by the financial constraints faced by the NHS, the guidance said.

CCG size
The BMA has recently recommended that CCGs should cover a population of 750,000 or over to ensure that they can cover all administrative and management costs and this was repeated within the guidance.

Larger CCGs could be made up of smaller locality groups of clinicians to lead commissioning for their area, the guidance said.

Alternatively smaller CCGs could form a formal federation, although the governance arrangements would need to be robust to give confidence to all CCGs in the federation, the guidance said.

The BMA has expressed its concern over the future of commissioning support for CCGs. The GPC has strongly urged the government to ensure that commissioning support units remain NHS bodies in order to provide cohesive support to CCGs, and a patient (not cost) focused approach.

The guidance document stressed the GPC's serious concerns that the ‘rushed timescale and lack of clarity on the ground’ means that many experienced and competent PCT staff, who are vital to CCGs, are leaving their posts.

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