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GPs buried under trusts' workload dump

LMC vows to block CCGs' attempts to commission primary care

Exclusive An LMC has voted to block any attempts by its CCGs to co-commission primary care over fears that practices would be subject to local performance management, Pulse has learnt.

Kent LMC held an urgent meeting and voted against the eight CCGs in the county taking on extra commissioning responsibilities that could see them introducing local QOF schemes, administering the GP contract and making decisions on opening new GP practices.

Local leaders expressed concerns that it could lead to an ‘inconsistency’ when dealing with breaches of contracts, while the lack of a clinical majority on co-commissioning bodies would lead to a ‘return to the days of PCTs’.

It comes as a Pulse survey has revealed that only around one in four GPs has been consulted about CCG plans for co-commissioning.

But the LMC’s intervention is the first reported instance of local GPs putting blocks in place for CCGs to commission primary care.

NHS England has given CCGs until January to apply for co-commissioning powers, but some GPs have previously expressed concerns that their contracts will be renegotiated locally.

Pulse revealed last month that a third of CCG leaders want new powers to performance manage the GP contract, and Kent LMC co-medical secretary Dr John Allingham said that this was a major concern for local GPs.

He said: ‘We are opposed to level three commissioning [full co-commissioning powers]. The problem with delegating to a local level is that your peers are sitting in judgement on your contract. We think it’s better if contracts like that are held centrally. If you delegate it down then there will be an inconsistency of approaches in dealing with breaches. It becomes more complicated.

‘The co-commissioning agenda requires a joint committee to be set up by a CCG and the area team, but we are concerned by plans for a lay or executive majority. This means that clinicians will be in a minority regarding decisions. It’s like a return to the days of PCTs. Doctors will be blamed for decision that they do not have the power to control.’

He said that the LMC’s intervention will be expressed at CCGs’ membership meetings.

Dr Allingham said: ‘This is not exactly a formal consultation but we have expressed our concerns. Most of our CCGs are holding or have held membership meetings to discuss this. To move to co-commissioning will require support from the majority of practices, and voting varies. To date we are not aware of any of our CCGs actively changing their constitutions. This may change.’

A spokesperson for the CCGs in the region said NHS West Kent CCG has agreed to opt for greater involvement in 2015/16, while NHS Dartford, Gravesham and Swanley CCG, NHS Swale CCG, NHS Medway CCG and NHS South Kent Coast CCG have not yet taken a final decision on which model they wish to adopt. NHS Thanet CCG, NHS Ashford CCG and NHS Canterbury and Coastal CCGs were unable to respond at time of publication.

It comes as a Pulse survey of 504 respondents revealed that some 222 GPs said they had not been asked for their views on whether their CCG should apply to co-commission GP services.

GPC deputy chair Dr Richard Vautrey said: ‘It’s simply not good that GPs are not being consulted. It’s imperative that CCGs both inform members and give opportunities to discuss the way forward about what level of commissioning is being proposed. Otherwise we’ll go back to the old days when senior managers just tell everybody what to do.’

The Pulse survey also shows that about a third of GPs – 175 – believe their CCG could do a better job of commissioning general practice than NHS England, while 84% of respondents said they did not have faith in NHS England being able to commission general practice efficiently.

Meanwhile, just 30% of CCGs’ five-year strategic plans have been agreed by ‘all parties within the health economy’, according to a survey of CCG finance directors by the Healthcare Financial Management Association. 

The data relates to responses by 64 CCGs. Most plans were partially agreed, but 5% of CCG plans were ‘not agreed at all.’

Survey results

Were you consulted by your CCG on whether it should apply to ‘co-commission’ GP services?

Yes: 27%

No: 44%

Don’t know: 29%

Do you think CCGs would do a better job of commissioning general practice than NHS England?

Yes: 35%

No: 37%

Don’t Know: 28%

Do you have faith in NHS England being able to efficiently commission general practice?

Yes: 4%

No: 84%

Don’t know: 12%

The survey was launched on 10 September 2014, collating responses using the Survey Monkey tool. The questions covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 560 GPs answered these questions.

Readers' comments (10)

  • In Kent, CCGs have demonstrated utter disregard for GP opinion. A glaring example is the closure of MH Wards in the Medway Hospital. Full co-commissioning powers with NHSE could mean that we would have to deal with a combined battery of CCG-NHSE in which, practically, CCG would have no say as NHSE would calls the shots. While we still pretend that 'we are the CCG', there could be radical shift in the balance and total loss of the little control we still have through CCGs. I support Dr Allingham's view - we need to tread carefully.

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  • This whole "delegation" of PC commissioning is being rushed as the NHS Chief wants to cut management costs at NHS England.
    CCG's will not get the extra management support in to do PC commissioning properly, but they will be held responsible.
    Ultimately, this will not be clinicial led commissioning as the Joint Committee for PC commissioning will have a Lay Chair and non-clinicians making the decisions.
    So, why is this any different to the current CCG-LAT system?
    Why do CCG's think they can do PC commissioning without any extra managers?
    In Birmingham, the CCG's cannot even commission secondary care well. So, why pretend you can take on PC too?
    From 2016, CCG's will have to take on pharmacy, dentists and opticians. Then they will be more like PCT's.
    I was PEC Chair for 10 years in our PCT and have a fairly good idea of what it was like and what this is going to be.

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  • LMCs are member organisations also, and will presumably have consulted on this. Is there a viable alternative (80+% say NHSEng unable to properly)

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  • Consultation in our area has been a letter sent out to all practices with 10 days to respond, I hardly call that an adequate consultation also practices and not individual GPs are being asked to respond which results in massive disagreement within the partnership which is not reflected in the response. In the end our practice did not respond because we felt that our views were not going to be listened to anyway.....

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  • Vinci Ho

    This is really a challenge to principles of democracy .
    The irony here is CCGs are GPs, LMCs are also GPs by definition.
    Questions are: (1)is this delegated power a real authority with autonomy for CCGs? OR CCG remains a puppet of NHSE(2) Do you need to dissemble this current CCG and have a proper re-election once new power is granted?(3)What is the guarantee that thing will not change again after general election?

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  • Vinci Ho

    In fact , the constitution if a CCG should be rewritten ?

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  • Agree, the constitution will need amending. Kind of like a referendum on any changes. Majority vote of GPs should decide, neither the LMC nor the CCG can decide unilaterally. The GPs have to vote - simples

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  • Any powers to CCG to devolve it from NHS England would be essential for safety of British public..National Health has let managers whether medically trained or not to issue dictatorial laws on GP prescriptions which have harmed the Public and British economy.This has been stated By Prof Brian Jarman in his BMj Editorial 2012;345:e8239 'when Managers rule Patients may suffer and they're the ones who matter' and also by Prof Michael Hands in his leters to Editor'We need aggregated data on bullying in the NHS(BMJ2013;346:f209>Pro. Tony Barnet is of similar views in his communications with me.

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  • If we disagree with our peers when it is our livelihood at stake what happens? We are member constituents and unlike with NHSE , we can potentially call for a vote of no confidence in the board and hold them to account.

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  • I hope the GPC is listening and this message of a vote demand will be passed on to all LMC before an unfavourable precedence is set in Kent.
    CCGs happy to lose their autonomy and partner with NHSE deserve a vote of no confidence.

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