Guidance issued by NHS England on Monday revealed the full extent of powers that can be delegated to GP-led CCGs from April 2015.
Under the fully delegated model CCGs will be able to manage contracts, including designing PMS and APMS deals, taking contractual action such as serving remedial notices and removing contracts.
CCGs will have power over locally agreed and nationally set enhanced services - LESs and DESs - and the design of local QOF alternatives. They will be able to establish new practices, approve mergers and award discretionary payments, NHS England has revealed.
Conflict of interest fears
GPC leaders have warned against delegating practice performance management which they have said could create conflicts of interest.
Performance management of individual GPs will not be delegated.
Under the alternative 'joint commissioning' model, CCGs will be able to exercise these functions in joint committees with their local NHS England area team. Under the third option, the ‘greater involvement’ model, CCGs' role will be limited to involvement in discussions on commissioning.
As previously reported by GP, CCG primary care commissioning committees established under the full delegated model will have to have a lay chair and majority to mitigate conflicts of interest.
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Representatives of the health and wellbeing board and local HealthWatch will also have the right to nominate a non-voting member.
Statutory guidance on managing conflicts of interest being developed with NHS Clinical Commissioners and Monitor will be published next month.
On resourcing, the guidance states that CCGs delegated commissioning powers will receive a ‘fair share’ of the area team’s primary care commissioning staff resources while area teams will retain what they require for their ongoing responsibilities.
NHS England’s policy of equitable funding for primary care should continue, the document said. Area teams should ensure that decisions on the future use of PMS funding should be agreed with CCGs.
Around nine out of 10 CCGs has bid for a role in commissioning primary care, and NHS England believes a third of CCGs are ready to take full control of primary care.
CCGs have until January to review and amend their prefered arrangements and implementation will begin in April.
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