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Independents' Day

Almost half of CCGs apply to take full responsibility for commissioning general practice

Exclusive Almost half of CCGs have opted to take on full responsibility for commissioning general practice, including performance managing practices and potentially introducing local incentive schemes to take the place of QOF, but GPC have criticised commissioners for failing to sufficiently consult with member practices.

The first deadline to apply for ‘delegated commissioning’ - Level 3 co-commissioning, the highest level - passed at noon on Friday, and Pulse has discovered that 42% of the 77 CCGs that provided information applied to take this on.

A further 30% of CCGs said they will apply for Level 2 co-commissioning by the 30 January deadline, which allows them to jointly commission general practice alongside area teams.

The investigation also revealed that the majority of CCGs applying to take on greater responsibility did not ballot member practices and had only garnered support at an open meeting, a move GPC said ‘falls far short’ of what it has called for.

This is the first indication of the extent to which CCGs will take over the commissioning of primary care from NHS England after chief executive Simon Stevens made co-commissioning a priority upon taking up his role last year.

CCGs were invited to submit expressions of interest for commissioning primary care in June 2014 and subsequent guidance unveiled by NHS England in November outlined the extent to which CCGs would be allowed to commission primary care, including the monitoring of contracts, offering alternatives to directed enhanced services and introducing local QOF replacements.

The deadline for applying for the highest level of commissioning passed at noon on Friday, and Pulse found that 32 of the 77 CCGs had applied for this.

Pulse has already reported that 12 CCGs had said they would use this responsibility to explore the possibility of replacing the national QOF with a local scheme.

Only 11% of CCGs wanted to take on Level 1 commissioning, which would allow them greater involvement in area team decision making, while 17% were still deciding.

However, a number of CCGs who were not applying for Level 3 commissioning this time round said they had plans to take delegated responsibility in the future when there was clearer information available on how this will work in practice.

Pulse also asked the CCGs whether they had put the decision out to a full vote of members, since opting to take on full responsibility or joint responsibility for commissioning primary care would mean making a significant change to the CCG constitution.

The investigation found that 25 out of 55 CCGs going for level 2 or 3 have not balloted members, 22 had done so and eight did not specify.

The GPC has advised that CCGs should put the decision about co-commissioning out to a full ballot of members.

Chair of the GPC contracts and regulations subcommittee Dr Robert Morley said: ‘Support in an open meeting falls far short of what the GPC guidance has called for - i.e. a proper transparently conducted ballot of member practices. [A] fundamental decision such as this which will involve significant change to the constitution [and therefore] must be in line with what the constitution stipulates.’

It comes as Kent LMC vowed to block any attempt by local CCGs to take joint or delegated commissioning responsibility for general practice, with Pulse’s new investigation revealing all Kent CCGs are now only applying for greater influence in decision making.

The GPC has advised that it resists delegated commissioning responsibilty where this includes member practices being contractually performance-managed by colleages.

It comes after Pulse reported that two thirds (66%) of CCGs expressed in their initial submission from June last year that they wanted full delegated primary care commissioning, including a third willing to take on contractual performance management.

CCG co-commissioning plans, and what they mean

9 (11%) CCGs have said they will take on Level 1 commissioning – Greater involvement, CCGs collaborating closely with their area teams

23 (30%) CCGs have said they will take on Level 2 commissioning – CCGs assuming joint commissioning responsibilities with their area team

32 (42%) CCGs have said they will take on Level 3 commissioning – Delegated commissioning, CCGs assuming full responsibility for commissioning primary care services

13 (17%) CCGs have not yet decided which level to go for

Source: Pulse media enquiry receiving 77 responses

Readers' comments (13)

  • The CCG's are going to be worse task masters than the NHSE with rising expectation and little resources except "just do it". this is a bad move for General Practice and further adds to demise of the profession.

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  • this is really no surprise

    slowly we are reverting to PCTs + privatisation.

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  • GPC fail to recognise that (as usual) the deadline for making the decision to adopt level 3 co-commissioning simply did not allow time to proerly consult with GP membrs of CCG's.

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  • This is going to end very badly indeed.

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  • Falling into the political trap. Doctors rationing doctors-just what they intended.
    The old wisdom-you cannot be both a poacher and a gamekeeper-is so relevant here.

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  • CCGs are led by the nose by NHSE so you can expect NHSE taking control under the guise of CCG which means anarchy galore and a final nail in the coffin for GP services.
    People in CCGs forcing the agenda are those connected to NHSE - look at the spider's web where the first thread came and you'll find they all come from that same melt. Is it surprising then that CCG yearn to have control which can be passed to pals in NHSE?

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  • This would only work if CCG's were granted the power to raise taxes or a license to print money . - It's simply a system for delivering blame when the cuts are forced on us . Just say no.

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  • The NHS has abandoned primary care for last 3 years - so CCG involvement is absolutely essential to revive it.
    We should not be worried about major performance management issues - PCT struggled with them and so will CCGs, as the NHS always has.
    If we don't give primary care some care and attention nobody will. Being left to the mercy of NHSE bureaucracy is best avoided at all costs.

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  • The CCG members had time to insist on a ballot of members. Failing that they have the right to remove the clinical directors including their clinical executives.
    In my opinion any CCG that has gone for level 3 without a membership ballot should be looking at a massive vote of no confidence at the next meeting of the membership.
    We will only have this option/power for a short while so we should use it

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  • We should all abstain from any votes on Co- commissioning and give the idea back to NHS England with a note stating "needs to try harder".

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