GP role in CCGs is being eroded, survey suggests

Just one in five grassroots GPs feel able to influence decisions made by their local CCG, a survey by the Nuffield Trust and King's Fund think tanks reveals.

The proportion of grassroots GPs - those without a formal role in their CCG - who feel able to influence decisions is down 15 percentage points since a high of 35% in 2014, the survey reveals.

Meanwhile, GPs responding to the survey said CCG managers, the DH and NHS England were more likely to be 'very influential' over decision-making than GPs on their local CCG governing body.

The findings come from research by the Nuffield Trust and King's Fund into the development of six CCGs that are 'broadly representative of CCGs across England'.

GP commissioning role

The research looks at CCG members' involvement in the organisations, relationships between their leaders and grassroots GPs, and CCGs role in supporting quality improvement in general practice.

Despite the findings suggesting a decline in GP engagement and influence, in a blog published on GPonline today, Nuffield Trust policy fellow Holly Holder argues that CCGs have still made significant strides forward in clinical involvement compared with their predecessor PCTs.

The survey also reveals that levels of engagement of GPs in CCGs have remained steady at just over 70% over the past four years.

However, Ms Holder warns: 'It is clear that one of the main objectives of CCGs – to increase clinical engagement in commissioning – is still falling short. All GPs should understand what is expected of them and feel able to influence the decisions in their area, including those without a formal role in their CCG.

'At a national level, policy-makers should ask themselves if, with all the requests being asked of CCGs, is it any wonder that some GPs are left pondering who is actually in charge of commissioning in the NHS? If NHS England wants to see local leadership in commissioning, they’re going to have to give CCGs the time and resources they need to properly engage with their members.'

Clinical engagement

GPs rated CCGs as the organisation with the greatest influence over their clinical behaviour - 62% of GPs said their CCG was either very or quite influential in this respect. The CQC was the second-most influential organisation, with 56% rating it as very or quite influential, while the DH and NHS England came third and fourth, with 49% and 46% respectively.

Around 25% of respondents felt GPs on CCG governing bodies were 'very influential' over the organisations' decisions, compared with 45% who felt managers were 'very influential'.

A total of 70% of GPs reported that their CCG was leading changes to primary care in their area, but many remain unconvinced about the development of co-commissioning, with 80% neutral or negative about CCGs taking control of commissioning primary care.

The poll findings also lay bare the toll CCG management roles are taking on GPs. A third of GPs said their CCG role had a negative impact on their clinical work, and 40% said they lacked the time to fulfil the role properly.

Meanwhile, the proportion of GPs on CCG governing bodies who felt highly engaged in the organisation's work has dropped from 83% in 2013 to 64% in 2016, the survey reveals.

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