The first year of clinical commissioning has seen some improvements in local health services. Local issues have been identified and local solutions found and as the Secretary of State recently said, commissioning is essential to developing services and improving safety in the NHS.
But the truth is, we don’t yet have enough control over commissioning. Practices are struggling to cope with increased demand, recruitment and training are falling, and GPs are finding themselves dealing with a high workload that is putting patient safety at risk. Regulation is growing but commissioning is disappearing.
I agree with David Geddes’ comments that planning for general practice should involve CCGs and be linked to population plans – but this is not happening yet. Too often, CCGs don’t get to see local primary care plans at all, and you can’t create a meaningful five-year plan without knowing the future of general practice locally.
Talk of practices failing for lack of money, for example, is unacceptable. Where practices fail to provide good quality of care, or see list sizes falling beyond viability, there may be an argument for change. But do we really want to see the demise of effective and popular practices due to underfunding, or not providing support fast enough?
This is not the same as a hospital running on a deficit: some GPs have not been able to take home any drawings after staff have been paid, which is obviously unsustainable.
And any reduction in primary care activity, or capacity, will have long term effects on local services and CCG plans mean little without GPs. There can be no significant shift of activity from hospitals without a service ready to accept the challenge.
Local area teams have an impossible task: actively commissioning hundreds of practices, each with a range of services, historic funding and performance variation is not feasible. So if we are to achieve local solutions to GP problems then it is vital that NHS England starts to co-commission with CCGs.
Urgent changes
Co-commissioning means creating joint responsibility and goals in order to improve outcomes. The ability for CCGs invest in new models of care for primary care and community services, for example, is crucial if we are to deliver the care needed for our patients out of hospital. There is little point in planning to reduce hospital capacity if GP services don’t get the corresponding investment in new models of care.
There have been concerns about conflicts of interest that might arise under co-commissioning but we should remember CCGs are statutory bodies who already have to produce clear and transparent plans on their governance, delivery and strategic direction, and this would not change with an expanded role into primary care.
This isn’t about GPs lining their own pockets: it’s an opportunity to get some development and funding for primary care, and it will be a vital ingredient if we want to do more. CCGs aren’t just about GPs but also affect patients, managers and public health. If collectively, we decide co-commissioning is the right thing for GPs to do then we must acknowledge the conflicts and protect against them through transparency and a relentless focus on what the patient needs. CCGs are about everyone – GPs, managers, patients and the local population – working together to find the right solutions for the patients and practices.
General practice is working hard against a tidal wave of pressures, but commissioning is a critical part of the UK’s health and social care system and I would urge GPs to join the debate. Get involved with your CCG to make sure the clinical expertise behind GP commissioning directs the NHS towards sustainable, high quality care for our patients.
At the moment, the way general practice is commissioned, isn’t working. Giving CCGs the power to co-commissioning is vital: if not us, then who? If not now, then when?
Dr Steve Kell is the co-chair of NHS Clinical Commissioners, chair of NHS Bassetlaw CCG and a GP in Bassetlaw.
