In a letter to GPs, GPC chairman Dr Laurence Buckman said in light of the current proposals GPs should be 'proactive' and form a CCG of the size of PCTs or PCT clusters.
The large-scale CCG should be underpinned by local 'sub groups', which are the current CCG structures, to ensure the CCG is sensitive to local needs.
It could now see CCGs in some areas covering populations of around 1m patients. The GPC had previously advised CCGs to cover a minimum population of 500,000.
Dr Buckman said by covering the same populations as a PCT cluster the CCG would be big enough to employ its own staff with the necessary skills and expertise to be an effective commissioning body.
He said: 'The CCGs could continue to work in the way GPs are telling us they want, but without the need to create unaffordable and duplicate governance structures.
'This would not be re-creating in a PCT, but would be led by clinicians who would ensure the smaller sub-groups were really empowered and enabled to take account of local needs.'
Dr Buckman also said GPs must be fully engaged with clinical commissioning to ensure they maintain a level of control over local service developments.
He warned that ‘chaotic change’ in the NHS would undermine any real influence clinicians would have over commissioning.
The BMA recently strengthened its opposition to the Bill following fears that clinical commissioning groups (CCGs) would be forced to employ large privately owned commissioning support organisations.
Dr Buckman wrote: 'This broad policy direction causes us deeper concerns about the risks to the NHS, given the potential for the vast majority of commissioning functions to be delivered by large multinational companies.’
Dr Buckman said the GPC was now calling for all GPs to get involved with clinical commissioning, despite the challenges presented.
‘GPs must now radically reassess the current situation in their locality and ensure they are fully involved to retain any degree of control in their local area and over the future of the NHS,’ he said.
Dr Buckman gave a number of key conditions that the GPC believes are vital to the positive development of CCGs.
One of the conditions was that CCGs required more than the £25 per head management allowance they were currently allocated. ‘We do not consider the proposed £25 per head to be sufficient and will be seeking a substantial increase in that sum,’ Dr Buckman said.
The GPC also stressed the importance of CCGs increasing their size, to match, or even surpass, the size of PCTs.
With a population of over 500,000 a CCG ‘would be big enough to employ its own staff with the necessary skills and expertise to be an effective commissioning body,’ Dr Buckman said.
‘Staff would work for the smaller sub-groups, the current CCGs, ensuring they were both protected and empowered within the devolved federation of the larger group,’ he added.
Dr Buckman said he understood that many GPs may find getting involved with commissioning ‘daunting’ but the GPC would continue to offer its support in that area.
‘The GPC will continue to produce guidance and provide support and advice to GPs to help empower you to influence local developments,’ he said.
