Most GPs do not feel involved in decision making at their local clinical commissioning group (CCG), a GP opinion poll shows.
But despite this finding, the vast majority rate their relationship with their CCG as satisfactory, good or excellent.
The survey of 200 GPs shows that 70% do not feel engaged with their CCG's decision making. The poll also shows that nearly half of GPs have not had a chance to vote for the leaders of their commissioning group, despite BMA advice that all GPs should be able to vote and stand for election.
One GP locum, who wished to remain anonymous, says: 'I do not know who they are or what they do or what CCG stands for.'
DH national clinical commissioning network lead for England and National Association of Primary Care president Dr James Kingsland says he is concerned but not surprised at the findings.
He warns that clinical engagement is 'missing from the core' of the NHS reforms. GP involvement 'is by far and away the most important aspect of CCG development', he says.
GPC deputy chairman Dr Richard Vautrey says that despite the popular belief that the majority of GPs are involved in commissioning, in reality only a very small number of GPs are actively involved.
'The vast majority are continuing to do the day job and have not really got involved,' Dr Vautrey says.
As well as poor levels of involvement, many respondents complain that they are still experiencing top-down control from their PCT or similar behaviour from their CCG.
Another GP who wished to remain anonymous says PCTs are not relinquishing control and that 'ideas from the grassroots seem to be ignored'.
Dr Vautrey says that many GPs are concerned that CCGs are 'adopting the worst practices of the PCTs'.
Dr Kingsland agrees. 'There are real issues where in certain parts of the country there are certain styles of developments akin to what we are trying to dismantle,' he says.
The survey asked GPs involved in commissioning if their commissioning work is properly resourced. More than 80% of respondents say it is not.
GP partner Dr Maria Uehlein said most CCG work is done in her 'free time'. She says the quality of patient care may suffer because of 'energy consuming' commissioning work.
Many GPs who took part in the survey said they were unhappy with the way their local CCG leaders were elected.
In a recent letter, GPC chairman Dr Laurence Buckman said: 'The GPC advises that all GPs in a consortium area should be eligible to stand for the transitional leadership and we also urge that, whatever voting system is chosen, it is vital that it is inclusive, and seen to be inclusive, of all GPs within the consortium's boundaries.'
However, 45% of GPs said that they had not had the opportunity to vote for leaders of their local CCG.
No opportunity to vote
One GP partner, who wished to remain anonymous, said that despite asking, GPs in his area had not been given the opportunity to take part in a vote.
The GPC has also advised practices against signing legal agreements with their CCG, but the survey found that more than half of practices had signed such an agreement.
Dr Vautrey said that although some agreements between practices and CCGs could be helpful, there was the possibility of some agreements being 'much more punitive'.