'Draconian' CCG legal agreements threaten GP practices

Clinical commissioning groups (CCGs) across England are forcing practices to sign 'draconian' legal agreements that could put their contracts at risk.

Dr Marshall: 'The agreements need to be practice-driven and owned, and not imposed by the CCG' (Photograph: NTI)

GP leaders have urged practices to refuse to sign the deals, warning that CCGs have no power to impose them.

But CCGs are requiring practices to sign 'inter-practice agreements', which set out targets practices must adhere to in order to avoid expulsion.

Practice contracts could be at risk because practices must be members of a commissioning group to hold a GP contract.

NHS Confederation deputy chief executive David Stout said agreements between practices must become standard practice as CCGs move towards authorisation.

An 'inter-practice agreement and constitution' drawn up by the East Staffordshire CCG warns practices may be expelled if they under-perform or fail to co-operate with its aims.

It sets out plans for practice-level financial information to be 'openly discussed' at CCG executive meetings.

Practices will also be monitored on the cost of their clinical decisions - those that overspend by more than 10% on their share of the overall commissioning budget must produce a recovery plan.

RCGP chairwoman Dr Clare Gerada raised concerns that the agreements could lead to inappropriate performance management of practices.

She said: 'The RCGP would recommend that practices work in federations, sharing good practices rather than dealing with it in what appears to be a draconian way.'

Tough new rules

An inter-practice agreement set out by the East Stafford-shire CCG sets out tough requirements for practices, including:

  • Attendance at nine meetings a year for an average practice.
  • Adherence to CCG priorities including national and local targets, efficiency savings and data analysis.
  • Maximum 10% budget overspend.
  • An agreement to work with the CCG to address 'underperformance' within three months.

GPC deputy chairman Dr Richard Vautrey said the agreements were 'inappropriate' and GPs should not sign them.

'CCGs need to be encouraging engagement and co-operation but trying to formalise it through some sort of legal contract is inappropriate.'

Dr Vautrey added that CCGs would be statutory bodies, similar to PCTs. 'PCTs have not found the need for such agreements and therefore nor should CCGs,' he said.

'Practices should just say: "No, there is no requirement for us to do this.".'

Dr Johnny Marshall, chairman of the National Association of Primary Care (NAPC), said: 'The agreements need to be practice-driven and owned, and not imposed by the CCG. It must be in that spirit and not something that feels imposed.'

Mr Stout said CCGs were acting prematurely by asking GPs to sign agreements now.

The DoH said it would be publishing a framework for emerging CCGs to support them in developing 'effective governance arrangements'.

An NHS Staffordshire spokeswoman said it was up to practices whether or not they signed the agreement.

But she added: 'Subject to the passing of the Health Bill, the legislation will identify practices that are part of the CCG. With the constitution this working arrangement will be formalised.'

The spokeswoman said the agreement reflected similar agreements put in place by other CCGs across the country.

She said: 'The inter-practice agreement was never seen as a legally binding document.

'It was developed to try to build a shared understanding of how practices will work together in the future.'

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