A GP survey found that despite just a quarter of GPs supporting CCG management of contracts, support is strong for certain elements of co-commissioning.
Almost 80% of about 600 GPs who responded supported CCGs designing new enhanced services, while 71% were in favour of them creating local alternatives to the QOF. More than half of GPs backed CCGs being able to establish new practices and monitor contract performance.
About 40% supported CCGs designing PMS and APMS contracts, and controlling discretionary payments. But there was less support for handing other functions to GP-led CCGs. More than 60% of GPs opposed giving them the power to remove contracts. Almost half opposed CCGs taking contractual action, such as issuing breach notices.
About 90% of CCGs are expected to take on one of three levels of co-commissioning from April, with many taking fully delegated control. Others will opt for shared responsibility with NHS England, or for greater involvement.
CCGs will not performance manage individual GPs, but under the delegated model, they will oversee contractual performance, budgets and complaints management.
Under delegated and joint arrangement models, CCGs will be able to design local incentives that could replace the QOF or directed enhanced services. This will not affect practices’ rights under the GMS contract.
CCGs will be able to vary, renew and commission new primary care contracts.
Despite opposition to many elements of co-commissioning, the GPC backs GPs having an integral role in commissioning primary care and has been urging practices to work harder to influence funding and workload decisions.
GPC chairman Dr Chaand Nagpaul has told GP practices to ‘stake their claim’ as CCG members. GPC deputy chairman Dr Richard Vautrey has suggested co-commissioning could allow CCGs to ‘level up’ funding for practices hit by recent MPIG or PMS cuts.
More than 85% of GPs said plans to allow CCGs to commission local incentive schemes would create variation in services. NHS England has said local schemes that replace the QOF could boost consistency of services by enabling commissioners to better respond to local needs.
About 64% of GPs surveyed agreed the move could help target funding at local needs, but 68% thought it would increase practice workload.
The GPC has warned practices could still be performance managed on QOF indicators, even if they opt into local arrangements, meaning more work for the same money.
CCGs taking delegated powers will have to form primary care commissioning committees with lay leaders, to avoid conflicts of interest.
But 73% of GPs surveyed said co-commissioning would make avoiding conflicts harder, and 63% said lay-led committees would undermine clinical leadership of CCGs.
Conflicts of interest
Many GPs said they feared possible conflicts of interest. One said CCGs should not have complete control. ‘It is an opportunity for unscrupulous GPs to predatorily take over other practices,’ said another.
Some GPs said CCG control may be preferable to NHS England. ‘Area teams don’t seem to have the capacity to commission primary care effectively,’ said one.
One GP added: ‘The CCG is probably the least worst place for these to be managed. Better a local organisation than the ever more distant area teams.’
Dr Vautrey said: ‘Local contracts may seem like a good idea, but if the protection of a national contract is lost, our experience of PCTs suggests practices soon find themselves between a rock and a hard place.’
GP Dr Amanda Doyle, co-chairwoman of NHS Clinical Commissioners, said many CCGs had worked with local GPs to agree co-commissioning plans. She said the transfer of powers ‘offers CCGs and their members the chance to work together as peers to enhance care for their patients’.