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GPs go forth

Third of CCGs have requested powers to police GP contracts

Exclusive A third of CCG leaders have requested new powers to performance manage the GP contract, in a radical move that could see them taking contractual action against their member practices.

A Pulse analysis of proposals submitted by 145 CCGs in June found that 32% had signalled they wanted to take on performance management of the GP contract.

At least 15% of CCGs said they wanted to take over complete control of the GMS contract from NHS England and 60% said they wanted a role with regards to PMS contracts, including negotiation of terms and PMS reviews.

The analysis shows that local commissioners across the country are keen to take control of huge chunks of the GP budget, when they are given the green light in April next year.

NHS Leicester City CCG said that a survey of member practices and the public showed that 53% supported CCG taking on a performance management role and deciding on sanctions, while NHS Surrey Downs CCG said that ‘performance measurement tools’ would demonstrate that ‘new innovations are not impacting on core service delivery’.

CCGs are expected to submit their final co-commissioning applications to local area teams in January, with the intention for level two commissioning to begin from 1 March and level three from April. But the Pulse analysis gives the first indication of what additional powers they may be asking for.

It reveals:

  • 37% of CCGs said that they wanted to be the decision-maker on, or influence decisions on, new providers, practice splits and mergers;
  • 56% want responsibility for for premises budgets;
  • 74% want to take on commissioning responsibility for DESs, such as for example the Avoiding Unplanned Admissions scheme;
  • 20% of CCGs want to be involved in managing QOF including evaluation of performance and managing appeals

Two-thirds (66%) said they wanted the maximum ‘level three’ responsibilities of primary care, which would allow them to act on behalf of NHS England, taking full responsibility for commissioning services with a delegated budget, although this will require central sign off.

Some 28% wanted ‘level two’ responsibilities, which allows them to jointly make commissioning decisions with NHS England and 6% wanted the lowest ‘level one’ responsibilities, limited to influencing area team decisions.

NHS England has recently opened up the scope of what CCGs will be allowed to do as part of co-commissioning, including setting up local QOF schemes. More detailed guidance on how co-commissioning will work is expected from NHS England early next week.

But there will be considerable opposition from the GPC.

GPC chair Dr Chaand Nagpaul warned that these reforms will threaten the national contract. He said: ‘These proposals raise many questions and our biggest issues are that we believe that the population is best served by a consistent national contract and this opens up the possibility of not having that.

‘It also mentioned it is permissive therefore of performance management of the GP contract and GPC has always felt that this carries an inherent conflict of interest. It is vital that these structures command the trust and confidence of their GP members and they need absolute assurance around probity.’

Dr Nagpaul added that CCG performance management of contracts was not appropriate: ‘Our position is that we do not think it is appropriate because there are inherent conflicts of interest in a CCG board holding and performance managing a GP contract from within its own area.’

NHS England has yet to specify whether CCGs will be able to performance manage member practices, saying ‘the question is open for discussion and debate,’ with the position set to be clarified next week.

Dr Steve Kell, co-chair of the NHS Clinical Commissioners leadership group, said: ‘What we have said all along is that co-commissioning brings an opportunity to get local, clinically led general practice at a time when it has become distant and transactional. CCGs have an important role in supporting and developing general practice and strong general practice absolutely central to CCGs’ plans.’

Readers' comments (17)

  • The thin edge of the wedge

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  • The real plan manifests. Welcome to the death of general practice in the UK. Independent contractor status is replaced by "animal farm" medicine

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  • whatever happened to our status as independent practicioners being able to make our own decisions....
    I have always enjoyed some semblance of freedom in my 25 year GP career, I can't believe we have allowed these brown tongued goody goodies at the CCG's ( 'voted' in by us ) push us into such a paranoid fearful state...
    time to retire

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  • It is just possible that, if you have good relationships with your colleagues locally, you may be able to work together to agree standards and improve care in a collaborative and supportive way.
    .......or am I deluded?

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  • 7.00pm - You are deluded or naIve. The large practices swallow the small practices by any devious means(lie,innuendo,deceit,complaint,GMC)until there is only one left. There are plenty of ambitious practice managers. Shakespeare would have enjoyed the slow back stabbing.

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  • Dr Nagpaul. I agree with everything you have said with one proviso. This is a conflict of interest and long term will destroy general practice. However, the national contract is so shite, it's not worth the electronic format it's written on. Is it really surprising that desperate practices (a la Somerset) are going down this route as the gpc is offering no feasible alternative.

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  • Took Early Retirement

    @7pm may be correct- in some cases. But if not, you can always vote your board member GP out. However, the boards don't seem to have a GP majority now, so this may not help.

    So what has all the re-organization achieved? I'd say a big fat zero other than some re-badging.

    From the sunlit uplands of retirement: I pity you all.

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  • CCGs are described as a membership organisation. If the local GPs do not like the direction of travel they can use their collective voice and stop it. Every CCG must have a locality board or equivalent. Find your representative and find your voice

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  • GPs voice concerns in monthly Meetings. CCGs say they are noting concerns. At the next meeting, the CCG speaker starts by saying - is everybody happy with the last weeks report - there is a unanimous 'yes' mumbled by a few who pretend they have read the report; and all the last month's concerns are buried - the CCG gets it's way.
    How can you expect anything form a passive profession or from people afraid to speak up?

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  • Constitutions of CCGs do not allow for contract management in the way this is shaping up. Before this gets any more legs - get lawyers to check out.

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