One of the most critical relationships in the new health system is that between CCGs and their member practices. CCGs need their members if they are going to succeed - they will not be able to meet the challenge of rising levels of chronic disease or to respond effectively to financial pressures without the support and involvement of local GPs. It is this relationship that potentially sets CCGs apart from their predecessors.
The quality of relationships between CCGs and their member practices is currently highly variable. The interim findings from a three year research project on CCGs being conducted by The King’s Fund and Nuffield Trust indicate that many GPs feel they have more influence over decisions made by CCGs than those formerly made by PCTs. However, fewer than half of over 200 GPs and practice managers surveyed across six case sites felt that their CCG was ‘owned’ by its members or that its decisions reflected their views. These figures fell to a third among respondents with no formal role in the CCG.
One issue that has a very direct bearing on this relationship is the role CCGs play in relation to GP services in their area. CCGs do not commission primary care, but it is becoming increasingly clear that they will need to play an active role in supporting general practice to evolve and grow - partly because the area teams of NHS England will not have sufficient capacity or the local relationships needed to do this alone.
Over 80% of GPs surveyed felt that CCGs have a legitimate role to play in this area, for example in terms of overseeing referral rates and prescribing costs. However, many GPs will ask what form this involvement might take. CCG leaders involved in our research were keen to avoid entering into any form of direct performance management relationship with their peers, and emphasised their intention to take a supportive approach, for example through provision of comparative performance data, and by facilitating various forms of peer-to-peer dialogue.
GPs have an opportunity to use CCGs as a mechanism for encouraging innovation and growth in general practice. Changes in society mean that new service models are needed which allow GPs and other practice staff to take greater responsibility for care co-ordination, adopt more proactive approaches based on a population health perspective, and support an expansion in the range of services available in the community.
If CCGs are to play a part in helping to bring about these changes, it is important that they remain grounded in their membership. It is equally important that GPs engage with the work of CCGs and make use of the opportunities they have to influence the way they commission services. CCGs are starting their lives during challenging times, with the system as a whole and general practice in particular under sustained pressure. The question is whether CCGs will be able to help address these pressures. The greater the level of involvement from local GPs, the better-placed they will be to do so.
Chris Naylor is a fellow in health policy at The King’s Fund and is one of the authors of the report. ‘Clinical commissioning groups: Supporting improvement in general practice?’ This is available from the websites of The King’s Fund and Nuffield Trust.
