CCGs have made clinical work worse, most GPs say

Three quarters of GPs do not think CCGs have improved patient care and many say they have adversely affected clinical work, according to a damning BMA survey.

BMA: poll reveals GP doubts over CCGs
BMA: poll reveals GP doubts over CCGs

Just over a year after CCGs took control of local health budgets, and as NHS England moves towards handing them co-commissioning powers over primary care, the survey results show most GPs are unengaged by the organisations.

Speaking at a Westminster Health Forum event on Thursday, GPC chairman Dr Chaand Nagpaul revealed key findings from the BMA survey.

While a large proportion of GPs felt more engaged with CCGs than they had been with PCTs, the results will be of concern to commissioning leaders pushing for greater powers.

The survey found:

  • Just 10% of GPs felt empowered as members of their CCG
  • Over 25% said they just did what they are told by the CCG
  • Two thirds felt they didn't really have influence or weren't really members
  • Only around one in 10 said they were able to challenge CCG decisions
  • One in five didn’t even know they could challenge decisions
  • More GPs felt CCGs had adversely affected their clinical work rather than improved it
  • Around 25% felt the CCG had helped improve care
  • The overwhelming majority said they could not engage with the CCG because of workload pressure

Dr Nagpaul said there was a ‘mismatch’ between the opinions of GPs on CCG boards, and grassroots GPs.

Grassroots GPs unconvinced

‘We broke down the response from those who lead CCGs, board members, and everyday GPs. When you ask the question, are CCGs improving care for patients if you happen to be a board member you overwhelmingly think "gosh we really are making a great change for our patients improving care". But if you ask your grassroots GP they don't seem to feel that way.’

Dr Nagpaul called for that mismatch to be addressed, warning that CCGs must learn from the past failure of practice-based commissioning.

‘The crux of CCGs being effective organisations has to be in getting the buy-in, the engagement, the sign-up, winning the hearts and minds, of everyday GPs,' he said.

‘The most important thing for those that lead CCGs...must be to see the world through the eyes of everyday GPs. Because change isn't going to delivered through blue sky thinking in board room. The only way you are really going to achieve change in the interface between GP and patient is to make that change in the consulting room.’

Focus on supporting GPs

CCGs, he added, should focus on supporting GPs, understanding the pressure they are under and only asking of them what is achievable.

Earlier, speaking at the same conference Dr Michael Dixon, chairman of the NHS Alliance and interim president of NHS Clinical Commissioners, warned that the greatest risk to the success of CCGs was their relationship with GP members.

‘Many of my colleagues regard clinical commissioning as a poisoned chalice or a noose, rather than a crown,' he said.

‘I regard it as the ultimate movement for general practice now to move into the NHS, be responsible for it, be able make the decisions. But, there is an accountability issue. And there are many of my GP colleagues who don't want to be accountable. They don't want to be responsible for limiting demand where necessary, for looking at their referrals and trying to reduce those that aren't appropriate.’

Dr Dixon said there was a ‘frisson’ between CCGs and practices, but warned that if general practice did not engage with the challenges of commissioning ‘it will become irrelevant and will wither on the vine’.

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