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Give CCGs the budget to commission GPs, says Dixon

CCGs should be handed the full primary care budget as NHS England are failing to invest more in GP practices, a leading commissioning expert has urged.

Speaking to Pulse in a personal capacity, Dr Michael Dixon, interim president of NHS Clinical Commissioners, admitted the idea was ‘controversial’, but that he had recently come to think that there was no alternative to develop a primary care-led NHS.

But his ideas were rejected by the GPC, who said it would result in conflicts of interest and mean GPs in CCGs would have to performance-manage their own contracts.

Dr Dixon told Pulse: ‘It’s a controversial and radical proposal and originally I wasn’t in favour of it, as it could set up conflicts of interest for GPs.

‘However, I now think there’s no longer any alternative, because NHS England are not able to perform on this.

’They’re having a great deal of difficulty in covering primary care and there’s not sufficient local sensitivity. We need much greater fluidity between primary care and CCG budgets. This is holding up a lot of good work that could be done by CCGs.’

PCTs commissioned both hospital services and primary care at a local level until April this year but NHS England took over commissioning primary care centrally to avoid CCGs having a conflict of interest as provider and commissioner.

Dr Dixon said there had been a hiatus in the development of primary care since NHS England took it over which, coupled with underfunding in previous years meant GPs weren’t able to provide the service they wanted.

He said: ‘A primary care-led NHS has been a joke over the past few years and history tells us we´ve done badly in the past. Last year, secondary care budgets grew by 1.4% while primary care shrank by the same amount. ‘There’s been a 50% increase in the number of hospital specialists in the last 10 years compared with a 4% fall in the number of GP partners. The movement has been going badly in the wrong direction.’

But Dr Richard Vautrey, GPC deputy chair said: ‘GPC does not support CCGs being given the budget for commissioning general practice. CCGs were not given commissioning responsibility for general practice at the time of the health bill reforms for good reason, to avoid conflicts of interest and avoid GPs in CCGs having to performance manage their own contracts.’

Readers' comments (7)

  • Not convinced Dr Dixon would feel able to handle issues such as this in a practice he commissioned:

    http://www.pulsetoday.co.uk/gp-commissioning-leaders-practice-deregistered-elderly-patients-for-financial-reasons/14062588.article

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  • Surely there is middle ground here that avoids CCGs managing their own individual contracts. If CCGs could locally help direct the quantum of investment in primary care e.g. be able to direct Area Teams to invest more on Primary Care in the geographical area that they commission care then CCGs could sensibly promote shift of resource appropriately without commissioning care directly from themselves - the Area Team would be responsible for an even handed approach towards primary care investment but CCGs could set the Pace of Change?

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  • Great idea. Let the GP's decide how much money to give themselves for doing their job. That sounds like a really good idea. No possilbe conflict of interest could possibly arise from that!!!

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  • Another example of the appalling mess that the disastrous reorgansiation has left us with.

    Unsurprisingly, NHS England is struggling to deal with locality issues and performance management of pirmary care on a national scale, even the Local Area Teams have too big a remit to respond to local needs, but the alternative suggested here has such enormous conflicts of interest it cannot be acceptable.

    What we need is a local organisation, independant from GPs, but with good representation from them, to commission, develop and support primary care, in conjunction with commissioning specialised services.

    I know, we could call it a Primary Care Trust...oh wait...

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  • Aha, right on time, the old power grab.

    Who the hell does this chap think he is, thinking he can tell me how to run my practice.

    One of the core strengths of Primary Care is its lack of hierarchy and relative lack of ladder climbing.

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  • I tried to think this through, but could not make sense of it.
    GPs are representing themselves and their colleagues on CCGs in a majority. They also are part of the executive making decisions, they are private businesses running a service provision. They decide where taxpayer money is spend on health care.

    Wo is strong enough to resist this temptation, particularly if one reads that the secondary care budget has risen by 1.4%?
    Ok all the costly stuff with higher technology and really expensive drugs is used in secondary care, not in primary care so all the advances are primarily paid out of secondary pots and the tariffs for procedures etc are set on tariffs costs from 3 years ago, but still, GPs have really had lost 1.4% of their budget. How much savings did other units had to make? 10%? Ups

    I don't think this is a good idea in principle, would be nice if CCGs had some influence on distribution of GP pots. This would allow some stick and carrot for getting the best put of primary care perhaps.

    In an ideal world however I think it would be great, what a dream.

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  • This is not a new idea (I even had a blog in Pulse about it recently), and one that has been implemented in models such the Health Maintenance Organisation, which (like the CCGs are supposed to be) are responsible for the health of their populations, and left to choose what to do 'in house', and what to subcontract.

    Such an arrangement would get rid of the 'conflict of interests' that bedevils most forms of procurement in the NHS, and would align the incentives for the CCG so that if they did move activity from the acute sector into primary care, they could be sure that the resource would move too....

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