A report by NHS Clinical Commissioners (NHSCC) – a group representing CCG leaders – called for
joint committees set up by CCGs and NHS England to be able to identify and decommission substandard GPs.
But senior GPs said CCG control over practice contracts could fuel ‘nepotism and favouritism’. Existing CQC and GMC powers meant there was no need to make contracts easier to remove, they added.
The report, Commissioning Primary Care: Transforming Healthcare in the Community, followed a roundtable policy discussion between representatives of NHS England, the GPC, the RCGP, CCGs and other interest groups.
It said the DH had consulted on legislative reform to allow CCGs to form joint committees with NHS England to exercise a CCG’s functions. This is expected to come into force this October.
The report said: ‘If this was taken to the next stage – allowing a joint committee to exercise an area team’s functions – it would greatly assist NHS England and CCGs in their goal of developing primary care.’
Existing ‘contractual rules make it hard for commissioners to take robust and timely action against underperforming GPs’, the report says. It adds: ‘Waiting for the chief inspector of general practice to take action is not enough. The rules need to be changed to enable commissioners to decommission GPs who are not up to standard.’
GPC negotiator Dr Beth McCarron-Nash said the BMA opposed CCGs commissioning or decommissioning GP contracts because of the potential conflict of interest.
While there was a role for CCGs to provide ‘local knowledge and input’, she said the proposals risked blurring lines of accountability and opening the system to claims of ‘nepotism and favouritism’.
Birmingham LMC secretary Dr Robert Morley said: ‘The idea that organisations made up of GP practices should be laying down the law to their, in effect, competitor practices, who are competing to provide GP core services, to put them out of business, is absolutely nonsensical, it’s barmy, it’s lunatic, it’s barking mad.’
GPC deputy chairman Dr Richard Vautrey hit out at plans to make contracts easier to remove. ‘Where poor performance is identified, it can and should be dealt with, and this can be achieved using the current arrangements,’ he said.
‘It is misleading to suggest that rules need to change to do this.’
Dr McCarron-Nash said the issue of poorly performing practices was ‘never as simple as good practices and bad practices’, but often involved complex factors.
Last month NHS England’s deputy medical director, former GP Dr Mike Bewick, told GPs in London his organisation was continuing to look at co-commissioning of primary care with GP-led CCGs.
Chairman of the Family Doctor
Association and Swindon GP Dr Peter Swinyard said he worried about CCGs holding powers over GP contracts because of the ‘risk of patronage where the few big practices get all the funding, and the others, which perhaps are difficult or don’t jump when someone says jump, find themselves starved of funding’.
Co-chairman of the NHSCC leadership group Dr Steve Kell said: ‘The development of primary care is most effective when there is close collaboration between CCGs and local NHS England area teams.
‘There are a range of well tested and effective mechanisms that can easily be put in place to ensure CCG decision-making processes remain open. Taking these steps would free up all parties, allowing them to remain accountable and still push local service improvements forward.’