But in a speech to the National Association of Primary Care annual Conference in Birmingham, Sir David Nicholson suggested a 'quality premium' payment to reward CCGs that improve outcomes and hit financial efficiency targets was likely to go ahead despite opposition from the BMA.
Sir David, also chief executive of the NHS Commissioning Board (NCB), said he wanted to see ‘innovative’ ways of working with CCGs to give more power and control over primary care commissioning.
The NCB will hold GP contracts, and the DoH has suggested it will be responsible for commissioning primary care services. But Sir David said he wanted to look at ways of ‘embedding the activities of the NCB in CCGs’.
‘I think we need to do some experiments,' he said. 'It seems it is a very important lever for the clinical commissioning group working collectively to have more control over the commissioning of primary care.’
In the coming years there will be an ‘explosion of data’ in primary care, Sir David predicted, because the quality of primary care is critical to the success of the NHS. He said: 'Some of this will be good, some bad. Some will absolutely drive us wild, but some of it will be really helpful.’
Sir David added: ‘We know that peer support, discussion and arrangements are probably the most powerful mechanism for change as we go forward in terms of primary care provision, so it is critical that we do that.'
In a wide-ranging speech, Sir David also suggested that the BMA’s campaign for the quality premium to be scrapped may not have been successful. He said details of how the incentive payment will work as well as indicative budgets of CCGs would be out before Christmas.
He also said while it is right that the configuration of CCGs was determined locally, the groups ‘have to be realistic’ and questioned whether some groups were being set up to fail.
Sir David also hinted that he was looking at ways of handing PCT and SHA staff a key role in commissioning support for CCGs.
He said there is ‘no way’ that the promise to allow CCGs a choice of commissioning support from 2013 will be broken, but he said NHS must ‘square the circle’ of the potential financial costs of making ‘huge numbers of [PCT and SHA] staff redundant’.
He said: ‘We are thinking very carefully about the way clinical commissioning support may be offered to you through clusters and through some services on a bigger geography.
‘The NCB is going to underwrite some of those responsibilities to ensure that we don’t turn around next year and find that everyone has gone. I am absolutely open to all sorts of opportunities, and I think the idea of CCGs being able to make choices between clusters [offering support] is a really good one.’