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CCGs to take over majority of GP budget, under NHS England proposals

GP practices could see the majority of their funding - including global sum, QOF, enhanced services and premises - devolved to CCGs within a year, according to a timetable released by NHS England.

CCGs have also been asked to retender co-commissioning bids by 6 January, which more than nine out of ten CCGs submitted an interest in, after complaints their expressions of interest were ‘incorrectly categorised.’

A ‘Proposed next steps towards primary co-commissioning’ overview, released last month gives details on what exactly GP commissioners could take responsibility from April next year.

It states that the functions ‘most suitable for full delegation’ by CCGs could include GMS and PMS contracts; enhanced Services (GP and Pharmacy, “LES and DES”); property costs; and QOF (for full delegation only).

It states: ‘We have not detected an appetite in CCGs to take on revalidation and performer’s lists, and many CCGs also believe that individual and practice performance management aspects of contract management should not be open for delegation.’

And it calls for feedback on whether further elements should be excluded or added.

Under the plans for co-commissioning primary care, announced by NHS chief Simon Stevens in May,  CCGs were able to submit plans for taking on added responsibility across three broad categories.

This includes giving CCGs greater involvement ‘in NHS England decision making’, and joint commissioning, where legislation was reformed to allow joint CCG, area team with a pooled budget.

The final option is for ‘delegated commissioning’ – the options outlined above - with CCGs commissioning primary care on NHS England’s behalf, was described by GP leaders at the annual LMCs conference as ‘the ultimate poisoned chalice’ for GPs.

The overview states this: ‘offers an opportunity for CCGs to assume full responsibility for commissioning primary care services’.

It adds: ‘However, for legal reasons, the liability for primary care commissioning remains with NHS England. Therefore NHS England will require assurance that its statutory duties are being discharged effectively.’

And explains that: ‘it is likely that co-commissioning will lead to an increased number of conflicts of interest for CCG governing bodies and GPs in commissioning roles.’

And says work with the BMA and RCGP is underway to handling these conflicts.

Dr Andrew Mimnagh, a GP in Liverpool and member of South Sefton CCG echoed this concern saying he felt the plans could be a way of NHS England divesting its more difficult responsibilities.

He told Pulse: ’There is brilliance in this chaos. By coincidence last week we had a full CCG away day, we had the entire CCG staff in a room, a reasonably small one and everyone in there is about a quarter of the workforce of a PCT previously.

‘So you’ve gone through a rearrangement that’s dropped it down, and the actual dynamic at the minute is that CCGs are being offered the “business as normal” activity of a PCT with a quarter of the staff.’

GPC deputy chair Dr Richard Vautrey told Pulse that co-commissioning posed two problems, in conflicts of interest and how the extra work CCGs take on would be resourced.

He told Pulse: ‘What we appear to be heading towards quite rapidly is a PCT-like organisation, so the conflict of interest issue would have to be resolved as part of that. The bigger question for CCGs is, have they got the capacity and resources to handle this?’

‘Because NHS England has struggled financially, and if it is simply going to pass responsibility but not any resources or personnel to deliver this, then that creates an added burden for CCGs, when they’ve got plenty of things to be getting on with, without this extra work and no resources to deal with it.’

‘With a national contract, that works because of economies of scale in the way that England as a whole, or the UK as a country can utilise that resource to manage a national contract.’

Related images

  • Simon Stevens - online

Readers' comments (14)

  • CCGs should stay well away from this. nHs England have done a poor (or no) job and hence they are trying to pass the buck.

    We have tried hard to maintain engagement with practices and this will make is the employer in a way and alter the relationship.

    The government will then blame CCGs for loss of quality in primary care due to government policies and hence will blame GPs. A lot more nrgative press for us.

    Those who say it will give us options to alter primary care are deluded as there is no money to do the current job let alone make changes

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  • Vinci Ho

    Interesting question is why now? Not earlier, not later.
    NHSE , of course, is fed up with 'moaning' GPs about their job(s). That's why Mr Stevens said what he said and my gut feeling us those who work inside NHSE are p**sed off with low morale as well . Nobody wants to dirty jobs. About time to throw that to CCGs right before general election. No doubt , many of our 'entrepreneur' (or the wannabe) colleagues on CCGs will be attracted.
    One possible outcome is numerous GP federations or collaboratives will be formed under their leadership , living under even tighter budgets. Yes, all our young ones( if there are still any) can choose to work as salaried ones as they will not fancy independent contractor status...........

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  • Hmmmm primary care is about to implode (already imploding) around the entire country due to retirements

    If I was in charge of commissioning primary care, I would be worried about my job and trying to pass the buck on to another organisation as soon as possible.

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  • How to get turkeys not only voting for Christmas but also plucking, basting and putting themselves in the oven.

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  • and how is this different from PCTs!!!!!!
    how about conflict of interest!!!!!!
    millions of pounds spent on re-organisation which could be better spent

    CCG in my area would b interested as run by managers and few GPs who are now 2-4sessions GPs and hence more like GP+nhs managers.

    I was offered a job in CCG but I declined because I did not want to cut down on my clinical sessions. Became a GP to look after my pts: all this nonsense will drive me away from by basic job.

    other advantage of working for CCGs is that will not be part of the GP income which they will have to publish on the webpages!!!!!!!!

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  • Transfer funding to CCGs then allow CCGs to be taken over by private companies ..hey presto! Job done

    Courtesy of Simon Stevens chief executive of NHS England, ex president of UnitedHealth Group Europe - a Private health care company based in Minnesota USA

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  • Have to have the transatlantic treaty ratified first, then his American Company can make full use of its' position to dominate UK Healthcare.

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  • 2.11pm. I may be wrong, but it's probably simpler than that even: it takes no time at all to register a UK company., wherever your headquarters are based. Again, registering with HMRC takes minutes.
    Theoretically, the necessity of CQC registration should complicate matters but I expect any new company with money behind it will be allowed a couple of years or so to comply "in the best interests of patients".

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  • 11.46- I think the current set up is much worse than the PCTs.
    We criticised them a lot, and often for good reasons, but at least most of them had relevant training and expertise.
    I'm sure there are some GPs on CCGs that make a positive contribution but the ones I've experienced appear to be completely out of their depth and don't even have the time to familiarise themselves with the procedural details or rules involved in commissioning and tendering.
    Combine this with having to work with the detritus of the former PCTs, the ones who couldn't get a better job elsewhere, and you end up with a clueless, rudderless committee.
    Last year several CCGs were under the impression that all LESs had to be put out to tender under AQP guidance. Completely wrong and rectified by LMCs actions but it emerged that the GPs and chairman odour local CCG had no idea of the rules.

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  • The public were never consulted about the vast changes to the NHS introduced by this governement.

    A complete corruption of our democracy.

    This abject failure of democracy in our country is why Scotland almost voted for independence and why so many people are turning to parties like UKip.

    Westminster is controlled by self interested cliques and no longer represents the people.

    A government that doesn't represent the people will sooner or later fall

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