A draft NCB document seen by GP magazine, titled Securing excellence in commissioning primary care and explaining how the NCB will commission £12.6bn of primary care, reads: ‘The following, carried out by some PCTs, will not transfer to the NHS Commissioning Board but will be the responsibility of providers themselves:
- Provision of locums and other temporary or support staff.
- Block purchasing of equipment and services other than the disposal of clinical waste.’
Asked for clarification, an NCB statement said: 'The NCB will continue to be responsible for payments to practices in line with the Statement of Financial Entitlements and there is nothing in this document that proposes any changes to existing funding support. The NCB will not, however, take on discretionary roles that some PCTs have chosen to provide for local practices such as organising provision of locums or block purchasing of equipment.'
On the austerity theme, NCB national managing director for commissioning development Dame Barbara Hakin said: ‘The significant reduction in management costs means some of the support PCTs gave practices in a quasi-employer role will be more difficult to do. The support just won’t be there any more. It was never part of their duty.’
Examples she gave included procurement for practices, training and education for staff.
She added: ‘I don’t want to suggest that all that won’t be available. But the reduction in management costs means that practices need to recognise that it will be more difficult to provide the services that PCTs did for practices in some places.’
The document also explains the ‘quality improvement approach’ clinical commissioning groups (CCGs) will take with the NCB.
It says this will include: ‘Evidence of engagement and involvement with patients and the public; benchmarking across member practices of healthcare needs indicators, interventions, and patient outcomes; commitments to openness about data and mechanisms to enable information sharing; clear approaches to peer review and discussions across member practices; self-assessment of need, intentions and anticipated impact.’
Dame Barbara added: ‘We need to identify the very small number of practices which aren’t delivering great services and find how we can make a difference there, whilst continuing to support the vast majority of practices and their great services.’
The document also explains the increasing influence of the public over service provision. It reads: ‘Citizens and communities will have a stronger voice to influence and challenge how health and social care services are provided.’
The document also appears to back GPC fears that CCGs may look further afield than practices when seeking to commission local enhanced services (LESs). It says: ‘These commissioned services will be more tightly defined and managed than those currently commissioned as LESs … Provision could include CCGs commissioning local services from existing GPs or other primary care contractors.’