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CCG budgets £1m per year in staff costs to take on co-commissioning GPs

Exclusive GP leaders are warning that co-commissioning could come with a hefty price tag, with one budgeting £1m in additional staff costs for delegated responsibility for primary care, Pulse can reveal.

This comes as NHS England confirmed that 77 out of 211 CCGs (36.5%) have so far applied to take on full delegated commissioning powers for general practice, which will see them taking full responsibility for all GP funding.

A Pulse survey of CCGs earlier this month revealed around 40% had applied for a delegated role in commissioning primary care.

But GP leaders have warned that practice funding will ‘inevitably’ suffer as CCG management costs increase.

Pulse has learnt that NHS Sandwell and West Birmingham CCG has applied for delegated (level 3) responsibility for commissioning primary care and it has budgeted close to £1m in recurring annual costs.

In board papers from this month, NHS Sandwell and West Birmingham CCG said that new staff with expertise in finance, contracting, quality, commissioning and partnerships would amount to £963,966 in additional annual costs, although it added that is was ‘anticipated that this level of funding can be reduced following further negotiation with NHS England’.

Andy Williams, the CCG’s accountable officer, said: ‘We have expressed interest in full delegation because we believe that this supports the integration agenda, which we see as important in addressing urgent care and improving patient experience. We have invited partners to discuss our approach to accountable care organisations and we are interested in both MCP and PAC models in principle at this early stage.

‘We have a primary care development workstream that is currently developing plans for the future of primary care. This will in turn determine our approach to areas of work such as PMS and enhanced payments. We have developed an implementation plan to recruit extra people to support these extra responsibilities, if agreed, and have identified the resources needed within our management allowance.’

Local LMC executive secretary and GPC lead on contracts and regulations Dr Robert Morley said: ‘An inevitable consequence of the move to CCG delegated responsibility for commissioning is that management costs are going to increase as CCGs are going to have to fund it from their own resources.

‘This will inevitably be at the detriment of funding for direct patient care, and, of course, there will be other costs on top of employment, including more training, strategy days, engagement of lawyers, accountants, management consultants and the rest, which they can never resist whenever there is any change or reorganisation in primary care management structures. And add to that the less quantifiable costs to general practices of yet more chaotic upheaval for them, with another transfer of the management of their core contracts when all the shambolic consequences of the previous upheaval are still being suffered.’

The GPC says that member practices should not be contractually performance-managed by colleages, however in the case of NHS Sandwell and West Birmingham CCG the drive to co-commission has the support of a majority of local practices.

In a ballot of members, where each practice got one vote but the result was later weighted based on list size, around 70% voted for full delegation, 25% for joint co-commissioning and 5% for no change.

Readers' comments (5)

  • was the post vote weighting part of their constitution?

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  • Let us also allow NHS FT to manage their own contract too, if OK for GPs/CCG then it should be OK for hospitals. Has NHS England really thought this through? Or is that a really silly question.

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  • GPs will not be managing thier own contracts. The CCG that co-commission will not have GPs on that part of the CCG due to conflict of interest, this has already bee outlined for CCGs. This makes a mockery of the whole CCG/ clinically led NHS. As we are members of the CCG it will be easy to point the finger at GPs but in reality we can influence and change sweet FA.

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  • "In a ballot of members, where each practice got one vote but the result was later weighted based on list size, around 70% voted for full delegation, 25% for joint co-commissioning and 5% for no change."
    Comments:
    1. having one vote per practice probably disenfranchises the junior members of the practice.
    2. this would appear not to have been a secret ballot if the votes could be weighted for list size - so another place where undue pressure, implicit or explict, might have been applied.
    3. what was the reason for undertaking weighting, and does the same method apply to all votes in the CCG? What does their constitution say about voting?
    It sounds as though single-handed and small practices might feel that their views were being over-ridden by this voting procedure, either in all cases (if it is in the Constitution) or in this very important case if the weighting only applied to this.

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  • Still on weighted voting in Sandwell and West Birmingham CCG.
    There seem to be 106 practices with list sizes from 312 to 17040 (HSCIC figures July 2014).
    8 practices, including the 2 smallest (312 & 790 - there is one with a blank in the list size column) have practice IDs starting with a 'Y': does this mean they are not GMS? & if so, do they have a vote?
    13 practices have list sizes above 10,000: 9 between 7980 and 9999: 67 practices have list sizes below the mean of 5227.
    So if there is one vote per practice *and* the published results are weighted before publication, I would be very interested to see the raw data - and the CCG Constitution.

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