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The waiting game

Local authorities demand role in commissioning primary care

Councils throughout London have written to NHE England chiefs demanding they be given powers to sign off plans that could see CCGs commissioning elements of the GP contract.

In a letter to NHS England chief executive Simon Stevens, the chair of London Councils mayor Jules Pipe has said that approval from health and wellbeing boards - which include representatives from CCGs and local authorities - should be a minimum requirement before any co-commissioning bids are approved.

They also suggest that local authorities and HWBs could play a role in managing conflicts of interest that may arise where GPs on a CCG board may be taking decisions that directly affect them or their colleagues.

NHS England is set to approve bids from CCGs for commissioning elements of primary care, which include plans to take control of directed enhanced services and QOF funding locally.

But the letter from London Councils dated 25 September says that local authorities should have a say over this.

It states: ‘The commissioning of primary care is clearly one important lever for bringing about a transformation of primary care in the capital and we believe local government has a positive role to play in the further development of your plans.

‘For local solutions to be really strong and able to secure widespread local engagement and support, they must be shaped by local authorities as well as CCGs.

It adds: ‘Therefore, as a minimum, we believe a condition for the approval of arrangements for co-commissioning should be the approval of the proposed approach by the relevant health and wellbeing board.

‘The need to avoid conflicts of interests in CCGs taking on co-commissioning responsibilities for primary care is widely recognised, and we believe that the boroughs and/or health and wellbeing boards could play a key role in overcoming this risk.’

The letter states that NHS England will approve, in principle, CCGs’ plans by 12 October, and calls on Mr Stevens to begin talks with local authorities before taking any further steps.

GPC negotiator Dr Beth McCarron-Nash told Pulse the scheme couldn’t be allowed to water down GPs’ voices. She said: ‘Ultimately, CCGs are membership organisations. I’m sure practices also feel that they don’t want to see a watering down of clinical led commissioning.

‘And we feel very strongly that one of the risks of co-commissioning is that it will add so many extra rafts of management and probity issues that come into play. That actually that voice of doctors and clinical commissioners gets watered down further.

‘So obviously CCGs will refer to overview and scrutiny boards and health and wellbeing boards as appropriate, but we need to ensure that the voice of clinical commissioners is strengthened not weakened further.’

At the annual LMCs Conference in York this year, GP leaders rejected the proposals for co-commissioning stating that the issues of conflicts of interest would amount to the ‘ultimate poison chalice’.

But Pulse reported in July that nine out of ten CCGs had expressed interest in taking on a greater co-commissioning role, with responsibility ranging from CCGs being more involved in area team decision making, up to CCGs holding budgets for commissioning parts of primary care.

NHS England is expected to put out further details on managing conflicts of interest in November.


Readers' comments (10)

  • Yet more ignorant know-it-alls with their political ideologies wanting to stick their fingers into the pot and give it a stir to create even more turbulence.

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  • Vinci Ho

    This is a recipe of chaos with 'conflict of interest' as the main ingredient . No wonder our young ones do not want to choose general practice .

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  • Councils have obviously seen what is going on with surgery closures. They worried what will happen to their economic and voter base if they become one of the towns with no GPs. Obviously there has never been any conflict of interest in town halls....

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  • Bin collection
    Flu injection
    What next?

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  • Took Early Retirement

    From what I have seen of the work of councils from within, they are largely as incompetent as the PCTs were.

    At least there will be someone to share the blame with GPs when a service goes tango uniform.

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  • John,

    I think that's exactly their thoughts - let's get GPs to share our failings.......

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  • I think GPs should have to sign off on all council decisions before they are finalised. Just as health decisions effect councils - council's decisions effect GPs. Things like opening or closing a nursing home, changing bins to weekly collection or closing a library or gym can have a significant effect on how often patients access primary care - so each practice should have a veto to decisions effecting their patients.

    If councils agree to that, I will let them have their input into health commissioning.

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  • Local authorities are in a mess, their funding has been cut, now some clever chap has thought they can stem the flow by plugging the gap in social care with the GP Primary care budget.

    Will we now also see the introduction of means tested healthcare being introduced under the guise of integrated health and social care?

    Yes we do need better integrated health and social care but not at the expense of losing primary care altogether.

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  • Again only a complete idiot would think of allowing social care budgets to get merged with health care or even consider allowing councils to have a meaningful voice. Oh wait a sec!

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  • Has anyone noticed that NHSE officials get DRD syndrome when it comes to meeting with Practices to discuss issues.
    (DRD=decision-making related diarrhoea). It's happend to me 4 times in a row and the dates were proposed and agreed by these same officials. And then they decline your request close the Practice list because you have not made enough effort to keep it open presuming xy&z because - they didn't bother to meet you in the first place.
    I wonder whether Council officials could be slightly better and more prone to treat you as Partners - couldn't really have a worse behavioural pattern, I would think ? We'll just have to wait and see.

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