CCG innovation 'stifled by too much guidance'

The NHS Commissioning Board (NCB) is stifling innovation by clinical commissioning groups (CCGs) by issuing too much 'top-down' guidance, a senior GP has warned.

Dr Michael Dixon: CCGs face too much top-down guidance

NHS Alliance chairman and Devon GP Dr Michael Dixon told a Westminster Health Forum event on implementing the Health Act yesterday in central London that the NCB was ‘full of secondary care’ and ‘still had a very top heavy centre’.

He said the NCB needed to give CCG leaders the headroom to innovate. Dr Dixon said: 'If you have trouble sleeping why not read the accountability framework for the NCB? It does look very old style, very top heavy. My advice to the NCB is to stop producing guidance and regulations at this rate. Let it be organic. And don't forget the reason and the point of why we are doing this.

‘The way the NCB is being set up is like saying to David Cameron and Nick Clegg "you can come into government but Gordon Brown is going to make sure you are fit for purpose and then he will tell you the rules and then he will come in and continually assess you and if he doesn’t like what you are doing he can come in and take over government". I mean would you ever create a revolutionary change in that way?

‘It is important that we keep the peer group signed up.' 

Chief executive of UnitedHealth UK, Katherine Ward, told the conference that she had heard a PCT cluster chief executive describe commissioning as 90% politics and only 10% based on data.

GPC deputy chairman Dr Richard Vautrey told the forum that CCGs are no longer just about GPs and for the reforms to be successful, they still need good managers. But he warned that the government risks alienating them because PCT managers have been facing redundancy for more than year.

He said it suits the DH to characterise CCGs as just being GP-led. He said: 'What does membership really mean? Every GP in a practice has been forced into CCG whether they like it or not.

‘The real leadership will come from frontline GPs but will they be able to lead from the bottom up or will it just be like PCTs?

‘Most GPs have had little choice about which CCG to join. Sessionals, which include locums, who make up 30% or 40% of the GP workforce have been excluded. That is a recipe for disaster from the start.

‘Some CCG constitutions are so draconian, over 100 pages long, that the vast majority of the membership are not even bothering to read them.’

Dr Vautrey warned that GPs could be the ‘fall guy’ if things go wrong in CCGs.

He said: ‘We need to move away from PCT performance management of practices. Practices should be holding CCGs to account.

‘It should be "my CCG, not the CCG".’

The NCB's national director of commissioning development Dame Barbara Hakin told GP: ‘We really are trying to get the balance right. Some CCGs I meet want us to give them more guidance so there is a mixed view. There is a difference between things CCGs should do and guidance that is helpful to them instead of them having to look for it 212 times.’

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