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Are CCGs a failed experiment?

Professor Azeem Majeed says CCGs have failed to tap into GPs’ clinical expertise, but the combination of GPs’ unique insight and CCGs’ statutory powers is vital for the future of the NHS, Dr Amanda Doyle argues

Prof Azeem Majeed

YES

One of the key aims of establishing clinical commissioning groups (CCGs) in England’s NHS was to place GPs at the heart of NHS commissioning. And yet surveys consistently show that many GPs feel that their views are ignored: an NHS England survey reported that just 44% of GPs said their CCG acted on their feedback. And a BMA survey reported that nearly two-thirds of GPs either feel they have limited influence on their CCGs or that decisions are forced on them with no room for grassroots contributions.

CCGs were supposed to make use of GPs’ clinical expertise in commissioning health services to improve health outcomes and patients’ experience of the NHS. However, a Pulse survey found twice as many GPs think the introduction of CCGs has been detrimental to patient care as think it has improved it.

In many ways, the fate of CCGs is linked with the consequences of the 2012 Health and Social Care Act that created them. The disruption caused by the Act just as the NHS entered a period of unprecedented financial pressure, clearly made it difficult for GPs and CCGs to function effectively. An example was the transfer of key public health functions from PCTs to local authorities, rather than to CCGs. GPs suddenly found they had little or no influence on local policies for services in areas such as smoking cessation and sexual health.

Many GPs have worked hard to try to ensure CCGs deliver what they set out to. Supporters of CCGs will cite financial pressures and primary care’s falling share of the NHS budget.1 But CCGs now control the majority of NHS funds in England. They could have done more for primary care services, and taken a stronger line against the demands of trusts.

Some CCGs have opted to take on co-commissioning of primary care services in addition to secondary care commissioning, effectively recreating PCTs (but still without key public health responsibilities). But, to prevent potential conflicts of interest, GPs’ role in such CCGs will have to be carefully regulated.

The Government plans to offer major cities in England control of their health budgets. GPs were not consulted on this proposal, which will effectively strip CCGs of many of their commissioning powers. 

In many parts of England, we will start to see the end of GP-led commissioning. GPs will continue to have a role but increasingly this will be an advisory rather than a leadership role.

Professor Azeem Majeed is professor of primary care at Imperial College London and a GP in the city

Reference

1 RCGP. A blueprint for building the new deal for general practice in England. May 2015. tinyurl.com/otpfwje

 

Dr Amanda Doyle-new-330px

NO

Far from being a failed experiment, clinical commissioning is evolving into a system that is focused on patient wellbeing as well as illness. I can’t think of any better commissioner for our healthcare services than CCGs, clinically led by local trusted clinicians who are making decisions specific to the needs of their patients and local populations.

CCGs were created with one simple idea – to harness the expertise and local knowledge of clinicians. The aim was to use this clinical insight and unique frontline relationship with patients alongside their statutory powers to deliver services tailored to their local populations.

The 209 CCGs across the English NHS are still young in terms of NHS bodies, yet they have been expected to reach full maturity almost as soon as they took their first breath. They have been expected to deliver the sort of service transformation that PCTs – with their much greater longevity – largely struggled to produce. They also need to maintain performance amid unprecedented demand, within the context of an increasingly tough fiscal environment for the NHS, and also for those care services with which the NHS has to work ever more closely.

Yet almost all CCGs have proven themselves capable of meeting the financial expectations of them. They’re beginning to take courageous decisions about how services must change if they are to be fit for the future. Last October, NHS Clinical Commissioners published Leading local partnerships,1 which showcases just a few examples from around the country of how CCGs are driving integration right across health and social care to reduce fragmentation and give patients the support they need.

It is true that CCGs as a whole need to work proactively to engage their GP practice members. Where this is already happening, it is accelerating the pace of change and inspiring clinical leadership.

CCGs need the freedom, flexibility and resources to make the bold decisions the NHS so desperately needs. Their new co-commissioning responsibilities in primary care give them the opportunity to start to join up care and offer those delivering frontline services the chance to become more actively engaged in the commissioning process.

Dr Amanda Doyle is co-chair of NHS Clinical Commissioners, chief clinical officer of NHS Blackpool CCG and a GP in the town

Reference

1 NHS Clinical Commissioners. Leading local partnerships. October 2014. tinyurl.com/ndseadp

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Readers' comments (16)

  • CCGs have struggled to recruit members for their executive boards. Rather than have hotly fought elections it has been a case of twisting GPs arms to get involved. Attendance at membership meetings is seen by most as an arduous waste of time. Local GPs feel like they have little influence on CCG decision making whilst the CCGs have little power over the hospital trusts or to secure a greater share of NHS funding to go to GP. CCGs often have recruited the same staff that worked in PCTs and behave in a similar manner.

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  • Historically a very mediocre cohort would do PCT work, they have merely moved to CCG committees. There has been to real cultural change.

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  • GPs have no real say. I am shocked and dismayed at the appalling decisions that the CCG took in what was my area until recently. The IAPT service was running pretty well with good reviews and easy to refer to. But the provider didn't even get through the initial stages of the commissioning process.
    Is it the fault of the CCGs or of the rules that they work under? Whatever it is, it cannot be right to lose providers who work so hard to get it right, instead getting these huge pseudo-NHS companies who take huge profits so they can pay the executives more.
    The NHS has truly lost its way.
    Will I get into trouble if I post this with my name?

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  • yet again GP's want the 'power' but either can't be bothered to get engaged in the debate about how that power is used (probably because the money isn't enough) or don't like the decisions that don't suit them. Scrap all of this bureaucracy and go back to the old Health Authority model.....and impose solutions that will work. I haven't yet met a GP who can see 'the big picture'

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  • GPs never asked for Health Authorities to become PCTs and then CCGs.

    We had no choice. What a colossal waste of money. We are clinicians not managers. We just want fair pay for our work, and we want to be supported in our work. We may be doctors but we have families too. We need a fair work life balance, and to be treated as human beings.

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  • Azeem Majeed

    Kaiser Chaudhri | GP Partner | 19 June 2015 2:58pm

    Kaiser Chaudhri makes the (correct) that many CCGs have struggled to recruit members for their executive boards. In my locality, when there was a vacancy, only one candidate stool for the post and was therefore automatically elected.

    In my professional lifetime, I have seem GP contracts change from being managed by Family Practitioner Committees, Family Health Service Authorities, Health Authorities, Primary Care Trusts and NHS England - and now with co-commissioning by CCGs.

    The majority of GPs never asked for any of these changes, which were imposed by the governments of the day.

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  • Azeem Majeed

    That should be 'stood for the post' rather than 'stool for the post' ......

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  • Azeem Majeed

    Kaiser Chaudhri | GP Partner | 19 June 2015 2:58pm

    Kaiser Chaudhri makes the (correct) point that many CCGs have struggled to recruit members for their executive boards. In my locality, when there was a vacancy, only one candidate stood for the post and was therefore automatically elected.

    In my professional lifetime, I have seem GP contracts change from being managed by Family Practitioner Committees, Family Health Service Authorities, Health Authorities, Primary Care Trusts and NHS England - and now with co-commissioning by CCGs.

    The majority of GPs never asked for any of these changes, which were imposed by the governments of the day.

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  • Vinci Ho

    My common sense tells:
    (1) When a system is intact , one will not need to rely on individual(s) which is subjected to variations in capabilities ,virtues and disciplines. Parliamentary democracy is a system we believe in the west but it is an indirect democracy with elected representatives to act for the voters in an election .
    (2) Then when you have a critical time in history, the system breaks ,especially when an instituition or a government is turning against people .Then you will have to rely on some individuals with visions to provide leadership in a revolution or non co-operative campaign. So called 'heroes' arose time to time in history .
    (3) Question is whether you believe the system is still 'intact' ? I have my own answers.......
    As I am very into Robert Plant's Stairway to Heaven lyrics lately , have we seen our piper? We need to stop 'rolling' and stand as a rock to a broken system preserving our principles......

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  • Azeem Majeed

    Vinci Ho | GP Partner | 21 June 2015 12:25pm

    Thanks Vinci.

    "Question is whether you believe the system is still 'intact' ? I have my own answers......."

    Perhaps you can tell us what your answers are?

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