Senior figures at both the BMA and NHS Clinical Commissioners (NHSCC) have insisted that responsibility for quality improvement in general practice sits with CCGs and that - especially in the early stages of their development - PCNs should not be expected to take this on.
The warning comes after one PCN leader told GPonline that the local CCG had repeatedly asked if her network had made contact with a surgery rated 'inadequate' by the CQC.
The clinical director said there was an expectation on the part of the CCG that the network would step in to assist the practice in a performance management capacity, adding that a lack of guidance had created a grey area that could lead to tension between CCGs and PCNs.
Performance management
Speaking to GPonline, BMA GP committee executive team member Dr Krishna Kasaraneni insisted performance management responsibilities had to remain with CCGs.
‘It is not appropriate for clinical directors to be asked to performance manage surgeries within their network – or take on any responsibilities that lie with the CCG, for that matter.
‘Clinical directors are under a huge amount of workload pressure leading their networks without being burdened with tasks that are not in their remit. Their primary role is to support their constituent practices and they should feel empowered to say no to unreasonable demands from the wider system.’
He added that the BMA would help to support any clinical directors who felt that they were being asked to take on responsibilities beyond those outlined in the network DES.
GP services
Meanwhile, chair of NHS Clinical Commissioners Dr Graham Jackson said: ‘GP services are at the heart of PCNs, so it’s crucial that practices are supported to improve where needed. However, the responsibility for quality improvement sits with the CCG, with the PCN being able to provide co-ordination and support.
‘As PCNs become embedded in the changing health landscape, commissioners, PCN leaders and practices will need to work together - supported by national bodies - to firmly establish sensible reporting and support structures.
‘Primary care quality and resilience is very important but it should be remembered that PCNs are fledgling structures and many are already feeling burdened by the "must dos". As they mature they will be able to take a more prominent role in system working and quality improvement.’
Last month clinical directors attending the RCGP annual conference said PCNs were struggling to resist CCG pressure to shape their priorities, with commissioners looking at local priorities in a ‘totally different way’ to network leaders.
CCG expectations
The PCN clinical director who spoke out about pressure from the local CCG said: ‘The bit that surprised me was the CCG's expectation that the clinical director was responsible for making sure that the CQC ratings were at a healthy level for all their practices and that they were performance managing their practices. They know that they can’t ask us to performance manage.'
The clinical director admitted it was likely to be in a network's interests to support local practices, because the collapse of a practice within a PCN could see patients move outside the area - affecting overall funding.
‘If we suddenly have a whole load of patients where that practice is dispersed and they go into another network for example, there would be a real financial viability question for us because all of our financial modelling is on that number,’ the clinical director said.
'It would have been helpful if there were some protocol or guidance as it's not something certainly - we're learning the quick and the hard way because we really haven't expected this.’
