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GPs quit CCG roles as commissioning enthusiasts lose heart

By Andrew McNicoll | 06 Dec 2011

Exclusive GP commissioning leaders are quitting the boards of clinical commissioning groups amid concerns that even enthusiasts for the NHS reforms are being ground down by excessive workload and frustration at bureaucracy.

A Pulse investigation covering 50 PCTs found 15 CCG board members have stepped down since April. Among those who resigned from board roles were CCG chairs and commissioning enthusiasts who found it impossible to juggle commissioning with their clinical work.

Board members have stepped down in Fareham and Gosport, Southampton, Wiltshire, Coventry and Warwickshire and Dorset.

Dr Patrick Craig-McFeely, a GP in Salisbury, resigned as chair of Sarum NHS Alliance commissioning group and stepped down from the CCG board last month. Dr Craig-McFeely, who was previously heavily involved in practice-based commissioning, said the experience had had a major impact on his professional and personal life.

‘It was taking over my family life and hitting the care I felt I could provide to my patients. It seemed to be getting ever worse,' Dr Craig-McFeely said.

‘When commissioning was announced it sounded like GPs would be able to do what they thought was right. But it has shifted to us being accountable here and accountable there and a whole lot of management speak. You never seem to be making any progress.'

The time pressures on CCG chairs have also led to one of the country's most prominent advocates of GP commissioning  standing down. Dr Johnny Marshall, chair of the National Association of Primary Care, quit as chair of the United Commissioning LLP, soon to become a CCG in Buckinghamshire, after he found it impossible to devote enough time to the role alongside his other commitments.

Dr Marshall, whose term as NAPC chair ends in January, said he will stay on the CCG board and remains committed. But a snapshot survey of 16 GP commissioners exposed further disillusionment and frustration.

One GP who asked not to be named warned of central pressures and said their CCG had been ‘told there is no point in trying to temper decisions of the SHA and Department of Health'. And Dr Gurmit Mahay, chair of Wolverhampton Primary Care CCG, said: ‘My diary has become blocked with CCG-related meetings, putting a strain on my other commitments. I have spoken to other CCG leads and they are all in a similar boat, with some ready to throw in the towel due to excessive pressure. Some are calling it "death by committee".'

The warnings come as Paul Corrigan, a former Labour health adviser, claimed diktats from PCTs and SHAs were leading to mounting disengagement: ‘What I have been hearing are stories of GPs told to come to meetings at eight hours' notice, rewrite submissions over a weekend and generally being kicked all round the room.'

Despite the difficulties, a number of CCG leaders remained positive. One said: ‘All change processes cause difficulties – it's a bumpy road ahead but one we will certainly travel.'

Dr Michelle Drage, chief executive of Londonwide LMCs and generally an enthusiast for commissioning, said GP engagement had reached a critical juncture as morale started to slide: ‘We're at the cusp – there's a lot of scepticism and de-motivation. We are beginning to see, even where people were very engaged, the PEC and PBC effect coming through.'

 

In GPs' words

‘The CCG role was becoming too much. I had to make a choice and in the end my priority was my patients.' Dr Patrick Craig-McFeely

‘The system as it is set up is heavy on meetings, which we as doctors are having to do on top of busy clinical schedules.' Dr Gurmit Mahay

‘I'm stepping down from the chair role as it really needs more time that I can commit.' Dr Johnny Marshall

READERS' COMMENTS

Anonymous, PCT,
06 Dec 2011
‘When commissioning was announced it sounded like GPs would be able to do what they thought was right. But it has shifted to us being accountable here and accountable there

I find it hard to understand how GP's ever thought that they wouldnt be accountability when collectively controlling £60bn or there abouts of public money.

It still is about GP's doing what they think is right but there was never going to be a free reign from the Centre to do what ever GP's wanted.
Average (8Votes)
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Anonymous, GP Partner,
06 Dec 2011
I'm sorry, but the above poster (Anonymus, PCT) really has no idea what a grass root GP like myself thought.

I did think we would be accountable - in fact I thought this is a ploy to dismantle primary care and place all blame on GPs. I still think this is the case. Who in the right mind will put someone who has no experience in organizational or large scale business management in charge of £60bn?

On the second bit about GPs doing what they think is right - where does this person gets this idea from? If you are involved with commissioning in anyway you will know the reality is far from this. Why will the GPs be able to do what they want - it creates too many ethical and financial dilemma and conflict of interest to allow this. I only get involved in commissioning as I'm forced to do take part in it, not because I want to or think its a good idea.
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Anonymous, PCT,
06 Dec 2011
Its very bureaucratic at our PCT at the moment. We have too many meetings at which too much paperwork is examined. The bottom line is that PCT and SHA staff don't have all the answers and feel as if they need to focus heavily on governance issues. I can understand this but it is very frustrating.

GPs would clearly prefer to focus on the major contracts. There is an opportunity to influence the next round very soon but I'm not sure how much will change will happen. GPs don't always have the same objectives and will want different things. Acutes will be looking for some stablilty and consistency rather than loads of differing approaches and priorities.

It all goes back to this principle of tearing up something that worked to a degree (PCTs) and replacing them with a concept that might work. Lansley should have brought GPs into most of the senior posts in PCTs AFTER the number of PCTs had been reduced. The truth is he wants private companies in to run the NHS at all costs.

PCT Finance Manager
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Anonymous, PCT,
06 Dec 2011
Welcome to the world of commissioning, bureaucracy not invented by PCTs, but required by the DH. This is tax payers money and you will be held accountable, there was never going to be any way around this.
Average (2Votes)
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Hugo Minney, Practice Manager,
06 Dec 2011
Innovation cannot happen with this much bureaucracy. We're trying to introduce new pathways, with hospital consultants and senior GPs involved in the pilots so that the patient pathways can be determined by expert clinicians. Then once the rules are decided, these services can be delivered by everyone else (nurses, AHP, less senior doctors) much more cheaply. Up until now we've had to contend with interminable (ie 4 years before anything gets done) meetings trying to discuss the requirement in the abstract, when the only way to find out what happens is to give it a go.
The NHS has to deliver services much more effectively (save £20billion). We can't do this by incremental efficiency savings of 1% here and 3% there. We need innovation.
£60bn does need to be spent well and wisely. And frankly, it won't be spent wisely if we perpetuate the bureaucratic nightmares of the past and if we drive the best people away
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Anonymous, PCT,
06 Dec 2011
Lots of good points above. Why are we smothered in bureaucracy??

I've just had a brief read of the first pages of the Operating Framework. Already I've felt suffocated by 'single national processes', National Quality Team, Health and Wellbeing Boards, NHS Outcomes Framework, NHS Equality and Diversity Council (I lie not) etc etc aaaarrrggghhh!!!

and none of the above was invented by a PCT

PCT Finance Manager
Average (1Vote)
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Anonymous, PCT,
06 Dec 2011
Hugo

A reduction in the bureaucracy would be welcome and Im sure there is plenty of scope. However most of it is there to protect patients from being experimented with and to keep the DH happy so it can keep the minister happy. I think the latter group could be reduced considerably if the Minister and DH were prepared to let it. However the NHS has always being centrally controlled and this current round of changes are going to do very little to change that despite all the spin.
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Anonymous, Manager,
06 Dec 2011
'Bureaucracy' to most GPs really means 'stuff we don't really understand very well because we are professionally trained doctors, not professionally trained managers'.

GPs might think managers are good at creating 'bureacracy' but professionally trained managers are usually very skilled at navigating them. No one sets out to create a bureaucracy, a social system creates the organisation's coded defence mechanism over many years. Its principal function is to reduce organisational risks. That does not mean bureaucracy is a good thing, but it is difficult to dismantle without unintended consequences. It takes more skill and time to dismantle a bureaucracy than it does to create one. There are very few GPs with the required competency in this area.

Whilst clinical commissioning is vital for the future of the NHS, this does not mean that GPs should run large organisations. I would argue that would be a disaster. Unfortunately, people do not know what they do not know about themselves and many GPs are deceiving themselves. The authorisation process for CCGs will send a lot of enthusiastic commissioners back to the drawing board. GP leaders who have not partnered with managerial leaders will be found out. The consequences of failing to grasp the bureaucracy early on will be dire for CCGs and their constituent practices.
Average (3Votes)
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David Brownridge, Sessional/Locum GP,
06 Dec 2011
At last the penny is beginning to drop! Let's hope for a stampede for the exits.
Average (3Votes)
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Siraj Shah, GP Partner,
07 Dec 2011
Bureacracy has now become a carcinomatous growth that is eventually going to destroy its host-NHS. The only way to salvage the NHS is by performing a radicle excision of this malignant growth "bureaucarcinoma" followed by total irradition to prevent any recurrence.
Average (2Votes)
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Anonymous, PCT,
08 Dec 2011
Dr Shah,

To perform the operation you have specified, get a train to London. In Whitehall you'll find the malignancy in large quantities. You will hear people talk about the NHS working together because they have developed a new tariff that focuses on patient outcomes. They will also speak about how the new Mental Health tariff will drive reform in that sector. I fear that it will be a long drawn out process of recovery as the patients are completely unaware of their illness.

PCT Finance Manager
Average (1Vote)
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Siraj Shah, GP Partner,
08 Dec 2011
I fully agree the primary focus of this malignancy is the Whitehall but that does not alter its management if we have to save the NHS.
Average (0Votes)
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Anonymous, PCT,
08 Dec 2011
Dr Shah,

Agreed - there are many who build their work lives around bureacracy - they swim in it. However, I would argue that the majority of public sector workers hate the sight of it but have little or no control over it.


PCT Finance Manager
Average (2Votes)
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