Commissioning: Why GPs have a vital role to play in shaping NHS services

CCGs have plenty of room for improvement, but these organisations have been far better at genuinely involving GPs in commissioning than many of their predecessors, argues King's Fund policy researcher Shilpa Ross.

If you are a GP, the fact that you are reading this suggests you’ve managed to find five minutes in between surgery, telephone consultations and admin. Given the pressures on general practice highlighted in our recent report, it would be understandable if what your CCG is doing isn’t uppermost in your mind right now.

Yet, new research carried out by The King’s Fund and the Nuffield Trust - published today in our report Clinical commissioning: GPs in charge? - shows that GPs and practice managers have been more engaged with CCGs than with other forms of commissioning used in the past.

CCGs took on formal responsibility for commissioning the majority of NHS care in 2013. Putting GPs in charge of over two thirds of the NHS commissioning budget went much further than previous reforms in involving them in commissioning.

GP commissioning

It sent a clear signal that GPs are best placed to make decisions about local care services for the patients they see every day. Clearly this bold move relied on GPs stepping up and wanting to get directly involved in something that is very different to the day job. With the commissioning landscape continuing to evolve, this willingness to engage is as just as important today as it was three years ago.

Our research shows that CCGs are having a positive impact. GPs responding to a survey we carried out earlier this year in six CCGs we’ve been following reported that they have more influence over clinical behaviour than other organisations, including the CQC and NHS England.

The majority of GPs agreed their CCGs had encouraged changes to the way in which primary care is organised, particularly by developing general practice federations – and half of those GPs felt such changes had led to improvements.

But the survey also highlighted a number of areas where engagement could be better. Few GPs without a formal role in their CCG felt the organisation was owned by its members and that the decisions it made reflected their views. Only 20% of GPs reported they could influence the work of their CCG if they chose to (down from 30% when we carried out the same survey in 2013).

CCG membership

And less than 40% of GP member representatives felt that being part of the CCG made their working life more fulfilling. We also heard that a lack of resources and autonomy are undermining the ability to make truly local commissioning decisions and making it difficult for CCGs to engage effectively with their GP membership. 

CCGs have learned over time about what works in engaging GPs in commissioning – you can read more about this in our report. This includes embedding clear and open lines of communication between governing bodies and GPs, and devolving some decision-making responsibilities to localities or member practices – including devolving budgets where appropriate. It also helps for CCGs to engage with general practice more broadly by involving practice managers and nurses in their work.

Although the commissioning system is still evolving, there are reasons to be optimistic about the future of clinical commissioning. The majority of GPs in leadership roles in their CCGs said they planned to stay in these roles for the foreseeable future. And research shows that 14% of GP trainees would be interested in taking on commissioning as part of a portfolio career.

So how to make the most of existing engagement and harness this untapped potential? Our recommendations to NHS England and the DH include providing clinical leaders with development support and training, and working with the royal colleges to promote commissioning as part of a rewarding clinical career. Some CCGs in our sample are already developing the clinical commissioners of the future by experimenting with new roles that allow GPs to gain vital experience by inputting into commissioning on a time-limited basis.

And just a final thought before you get back to your urgent work: why does your engagement in commissioning matter? Clinical commissioning is key to planning local services and shaping the direction of changes to come. We don’t claim to know the future for CCGs, but we do know that a strong clinical voice in these decisions is essential to ensure they meet patient needs.

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