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CCGs should be able to take action against underperforming GPs, claims report

CCGs should have power to ‘decommission’ GPs and practices that aren’t up to standard, commissioning leaders have said.

NHS Clinical Commissioners said that despite CCG efforts, ‘poor practice persists’ and currently CCGs are left ‘waiting for the chief inspector of GPs to take action’.

In a new report, they call for better identification of failing GPs and practices and for NHS to support action with ‘contracting levers’.

The ‘Commissioning primary care: transforming healthcare in the community’ report read: ‘Poor practice persists, however, and the contractual rules make it hard for commissioners to take robust and timely action against underperforming GPs. 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; CCGs need to be robust in identifying individuals and practices who are failing, with NHS England supporting that action with the appropriate contracting levers.’

The report also challenged the current framework for primary care commissioning and is particularly critical of Area Teams, labelling them ‘distant and transactional.’

The report stated: ‘In many areas CCGs have been waiting for area teams ro come up with comprehensive primary care strategies that have, largely, either not been forthcoming or been drawn up with little CCG involvement.’

‘Local area teams have limited capacity to expand and reform primary care because they are being forced to spend most of their time on contracting process [sic].’

To remedy the situation, NHSCC called for NHS England to grant ‘more autonomy’ to CCGs.

The report read: ‘Greater autonomy in deciding in their local approach to primary care commissioning, rather than adhering to a single operating framework.’

Meanwhile, NHS CCG also argued that practices need to accept greater transparency and accountability measures – such as publishing GP pay – as the ‘price’ for transferring more resources from secondary care into primary care services.

Dr Steve Kell, co-chair of NHSCC, 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.’

NHS CC’s report claimed to set out key messages from a roundtable event with CCG leaders and representatives from the NHS England, BMA and RCGP in November, but is published solely by NHS CC.

It is not the first time GP leaders have called for more stringent controls on GP practices, and CCGs began monitoring access to GP services already in 2012, when still in shadow form.

Readers' comments (13)

  • Who takes action against NHS England when they underperform?

    Why isn't the payment situation sorted out yet?

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  • When underperforming means not doing what you're told - watch out !

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  • And how will they define "under performing"?

    GPs with high AB prescription?
    Or referral rates?
    Or AED attendance?
    Or number of appointments?
    Or patient satisfaction rates?
    or Cancer detection rates?

    We all know these parameters have variation according to the patient population. Will a University practice with low referral rate be deemed "good practice" against suburban practice with high elderly population? So how will this be equalled out?

    And who will enforece this as a legal definition to terminate a contract? Any GP surgery will fight back with their solicitor and with no defined criteria the arguement could go either way.

    This is riddled with controversy and I'm afraid sinical ol' me think this is NHSE passing poisoned chalice to CCG.

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  • Maybe ccg is best placed for this.
    But supportive help and re-education first line.
    (As long as performance is not actually dangerous)

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  • Peter Swinyard

    The LMCs need to be involved. Are we talking failing practice or poorly performing doctor? In the latter case, the LMCs/PCTs often had good arrangements to deal with this which got rather swept away last April. New models are emerging but not really established yet. Really is an LAT issue - dumping on the CCG as opposed to taking advice from the CCG seems inappropriate. CCGs are not [yet] our contract holders.

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  • As per anon 11:37. Poorly performing might mean those who refuse to engage with the CCG, those who are maverick, those who are outside the norm, those who refuse LES’ DES’ & ‘extra unpaid work’.

    "When I use a word,' Humpty Dumpty said in rather a scornful tone, 'it means just what I choose it to mean — neither more nor less."

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  • Given all the small things CCGs are scared of doing due to risks of conflict of interest would a CCG really want to mess with the contracts of its own members?

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  • Our contracts are with NHSE, not the CCGs so don't try to dump more work back by trying to make GPs police their own contracts via the CCGs thank you!

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  • CCGs don't hold responsibility for primary care contracts for General Practice - this remit falls under NHS England. CCGs are already dealing with 'devolved' responsibilities for NHSE!

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  • this is scaremongering, can't work out if this is a journalistic exaggeration or something serious!

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