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Revealed: Majority of GPs no more involved with commissioning under CCGs

Exclusive: The majority of GPs feel no more involved in commissioning decisions than they did before the formation of CCGs, according to a Pulse survey which lays bare the professions’ concerns on the eve of the 1 April handover.

Pulse’s snapshot survey of 303 GPs in England reveals the extent of GPs’ disengagement with clinical commissioning just days before the profession assumes responsibility for budgets. Some 55% of respondents said they did not have any more involvement now than they did under PCTs. Just 36% said they did feel more involved.

One in five GPs said they had not signed their CCG constitution, raising questions over the depth of GP engagement at CCGs. Of the 48 GPs who said they had not signed their constitution, most said they had not been asked to, while three said it had not been finalised or had only just been circulated in draft form.

A further 20% did not even know whether or not their practice had signed a constitution.

GPs are also seeing increasing levels of performance management by CCGs, with 83% reporting some sort of pressure from CCGs, despite assurances from the NHS Commissioning Board that this is not the responsibility of CCGs. Some 16% said they had faced a lot of pressure to improve their performance.

The results come after CCG leaders accused the NHS Commissioning Board - now known as NHS England - of a ‘command and control’ mentality when dealing with CCGs.

Dr Chaand Nagpaul, GPC negotiator, said the results called into question the ethos of the Government’s reforms - described by then-health secretary Andrew Lansley as putting decision-making ‘in the hands of professionals’.

He said: ‘The Government had pushed through this agenda at breakneck speed. That did not allow for adequate involvement and organic development for engagement.’

He added that rising levels of performance management by CCG boded ill: ‘This is a recipe for disengagement. If practices feel they are being performance-managed contractually, it will create the potential for adversarial relationships between practices and CCG boards that will replicate the dynamics between practices and PCTs.’

Dr Robert Morley, secretary of Birmingham LMC, said he was worried by the attitude of some CCGs to their constituent practices.

He told Pulse: ‘Of course CCGs have “engaged” with their practices, as every practice has to be a CCG member, and some CCGs I’m sure have done a good job of this. But others have done far less well.’

‘When I look at some of the pronouncements coming from certain CCG leaders across the country, and some of the unacceptable obligations they are trying to put on practices, particularly in their constitutions, which we now know are to be legally binding documents, it makes me shudder.’

CCG survey figures 1

Dr James Kingsland, national clinical lead of the NHS Clinical Commissioning Community, and a GP in Wallasey, Merseyside, said he was hearing ‘mixed reports’ from CCGs about their enthusiasm for the changes and their engagement with practices.

He said: ‘Some CCGs are saying clinical leadership is flourishing, practices are engaged, they are facing their public.’

‘[But] others are saying it feels very much like the relationship between the SHA and PCT, where we are facing a reporting system to demonstrate we have done certain things that are required by the area team, which is concerning as we are supposed to be having a completely new system.’

The Department of Health was approached for comment but did not respond ahead of publication.

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Find out what commissioning means for you and your practice at Pulse Live, our new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (7)

  • So basically the whole foundation of the health and social care bill has failed to be realised making it a total and utter waste of time and money? Well thats a surprise!

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  • That will be those that don't want to be involved then.

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  • Don't want to be involved or don't have the time to be involved?

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  • Creeping Orwellian deprofessionalisation of NHS now rising to a trot en route to fragmentation. CQC 1/2 fees out today is a good example of pointless bureaucracy now brilliantly privatised so the inspected now get to pay for this .Only the supine BMA remains mute. Why not ask teachers or prisoners to pay for their "inspections".

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  • To continue that argument should the government pay for our car MOTs?

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  • Sadly the only people who will be affected by this are those in most need of care. The plethera of cheap health insurance adverts running in the press recently shows that the CON-DEMS have produced a private NHS by apathy. This is not fixable, the money blackhole that is the NHS will help Bullingdon George balance the books but this farce will help nobody.

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  • Vinci Ho

    May be the only philosophical way for us is to take one step back in our thinking :
    For those who still believed that this government still got a fortune , more will have to be 'promised' towards the deadline of 2015 election . Yes , we have no choice for another two years of war against terror and bullying . Who is to win the war? We shall see.
    For those who do not believe with all these political lies , all we need to do is to protect our patients and educate them in the 'right' way......
    'For those who are evil will always get their punishment , those who are kind will alwags get their reward . The only reason why these punishment or reward have not happened yet is time , the right time '..........

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