GPs split over plan for CCG control of primary care commissioning

Grassroots GPs will oppose key NHS England and DH plans to hand CCGs powers to co-commission primary care, leaving the profession facing a split over the issue.

Dr Amanda Doyle and Dr Greg Place (Photo: JH Lancy, Alex Deverill)

Local GP leaders have said they believe this month’s annual conference of LMCs in York will vote to oppose a wider primary care role for CCGs.

This comes after GP commissioners welcomed the announcement by health secretary Jeremy Hunt and NHS England chief executive Simon Stevens revealing the first details of the long-mooted policy. 

Speaking at an NHS Clinical Commissioners conference in London, Mr Stevens said proper resourcing of primary care required CCGs to have greater influence over funding.

Invitation to bid

NHS England will invite CCGs to bid for co-commissioning powers by putting forward proposals to advance integration, raise standards and reduce health inequalities.

Mr Hunt said the ‘ambitious, exciting’ move would free CCGs to ‘craft the entire out-of-hospital plans’.

GP leaders responded cautiously to the announcement, with GPC deputy chairman Dr Richard Vautrey calling it a ‘predictable’ step towards ‘recreating PCTs’. It was a sign NHS England did not have the capacity to commission primary care well, he said, and that the fragmented NHS was ‘failing to deliver’.

Dr Vautrey warned that overcoming real or perceived conflicts of interest was now the key concern.

But LMC leaders will vote on 22 May on a motion expressing ‘alarm’ at plans for CCG co-commissioning of primary care. The plans, confirmed by NHS England in March, could ‘fatally damage relations between CCGs and their constituents’.

Dr Greg Place, chairman of Nottinghamshire LMC, which will propose the motion at the LMCs conference, said as well as the potential for conflicts of interest, CCG commissioning of general practice could undermine the national contract.

The move risked introducing further ‘postcode variation’ of services and funding, he said.

Birmingham LMC secretary Dr Robert Morley agreed that only the national contract commissioned by NHS England ‘guarantees recurrent funding for practices’.

Co-commissioning, he said, risked ‘little bits of funding for piecemeal delivery of care’ with ‘often no guarantee it will continue long-term’.

Expanding CCG role

Some GPs also fear the expanding role of CCGs, a year after they gained their powers. CCGs should be in-volved in what primary care does, said Dr Place, but should not be commissioning core GP services or be seen as the voice of GPs.

‘Our colleagues working in CCGs are not frontline GPs any longer,’ Dr Place added. ‘They have divorced themselves from the mainstream.’

He said there was a lot of feeling among grassroots GPs that CCGs, encouraged by the DH, are driving the agenda in general practice and becoming less about clinical commissioning and more like the old PCTs and health authorities.

But NHS Clinical Commissioners co-chairwoman Dr Amanda Doyle said CCGs are ‘the local organisation that understands general practice in their area’. GPs, she added, ‘would welcome greater involvement from the CCG’.

Some GPs are concerned that co-commissioning could undermine effective clinical leadership by cutting GP commissioners out of many decisions, to avoid conflicts of interest. Dr Bruce Hughes, chairman of Devon LMC, which submitted a motion opposing co-commissioning, said the clinical leadership of CCGs would be ‘diluted’.

‘We’ve got good clinical leaders in CCGs and we will weaken CCGs if they are not able to operate in the way they have,’ he said.

Dr Hughes believed the conference motion would be passed. ‘The main fans of co-commissioning are CCG clinical people,’ he said. ‘It’s understandable, but perhaps we need to save them from themselves.’

NHS England is writing to CCGs now, inviting expressions of interest in co-commissioning.

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