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GPC alarm over 'unacceptable' micro-managing of GPs by commissioning groups

By Gareth Iacobucci | 07 Oct 2011

GPC chair Dr Laurence Buckman has said he is ‘increasingly alarmed' by the manner in which some clinical commissioning groups are being set up and run, in the GPC's harshest assessment yet of the progress of the Government's NHS reforms.

In a letter to the profession today, GPC chair Dr Laurence Buckman warned some clinical commissioning groups (CCGs) were using ‘untried and unacceptable measures' to performance-manage colleagues, and said there was only ‘a limited window of opportunity left' for the profession to influence the development of commissioning.

 

Dr Buckman's intervention comes after Pulse recently revealed that 95% of GPs appointed to the boards of CCGs have not faced a contested election, amid claims of a ‘jobs for the boys' culture and widespread disengagement among grassroots general practice.

Dr Buckman said: ‘I am becoming increasingly alarmed by the manner in which some CCGs are being established and are operating. There is a limited window of opportunity left for us to influence the development of CCGs.'

He went on to outline the GPC's main areas of concern, including a lack of ‘any adequate democratic opportunity' in some areas and LMCs being ‘sidelined and ignored'. Download the letter here.

The GPC is also worried that in some areas, CCG board members have put in place ‘untried and unacceptable measures to micro-manage practices, irrespective of the views of local GPs', and expressed fears that CCGs will only be authorised by the NHS Commissioning Board where they ‘bear a remarkable resemblance to PCTs'.

Dr Buckman said the GPC continued to hold wider doubts over the health bill, particularly around the increase of competition through the enforced roll-out of ‘any qualified provider'. The GPC ‘remain seriously concerned' that potential incentives or financial reward for commissioning – such as the quality premium - will damage the doctor-patient relationship, he said.

He added: ‘Vested interests need to be removed as do actions which do not improve patient outcomes. CCGs and PCTs need to work with LMCs, following the example we have seen in areas where there is constructive working. This is the only way that positive changes will be made.'

Download the letter here.

READERS' COMMENTS

Vinci Ho, GP Partner,
07 Oct 2011
Political beliefs of the CCG board members will govern their behaviour and how they will treat their colleagues in the consortium ,for instance.
When we used to complain how restrictive PCT managers are with all kinds of bureacratic tools ,they are merely employees of the state .They have to do their job to survive incliding pleasing their superiors. We ,GP ,are hybrids of independent contractor and public servant .(In good times , golden child. An orphan in bad times). We retain some freedom and autonomy though. One can debate this could be a weakness to the system somtimes , the priviledges actually provide us the strength to look after the best interests of our patients as we are the only professionals(Jedi) closest to them .
Here we come ,I can hear the critics coming ,' About time to teach you guys a lesson. You really think you are so important. We can do with alternatives!'
Clearly , with the reforms , the government is preparing its way to destroy general practice of its current form in this country .(I called the current version of Health Bill 'Blueprint of the Death Star' ).
Worst of all , the most devious plot to destroy a tribe is by using its own people to control and police the rest. History has been repeating itself time and time again.
Hitler ,Stalin ,Mao ,.....
People need to wake up and identify the real enemies of NHS.........
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Anonymous, PCT,
10 Oct 2011
This isn't a case of the PCT reforming, its more a case of make it up as you go along. The same old faces are there from PBC leads not PCT. How many last chances do GPs want to try and step back from the mess?

I might get a job in the new setting but I have no confidence in those currently leading the Consortia as they are looking after themselves first and foremost. Given half a chance I'd rather work for the NHSCB/DH/doomed Cluster etc. Please - certain GPs... don't fool yourself that you would be losing a bureaucrat. I'd want to leave because I don't want to be part of a bureaucratic disorganised mess.

PCT Finance Manager
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Peter Patel, Manager,
10 Oct 2011
One can only be micro-managed if one has signed the CCG's Inter-Practice Agreement (IPA) which allows their practice to be part of an agreed performance management. If GPs do not want to join the team and feel that there is micro-managment then they can by majority vote change their IPA and operating structure to provide for best practice for QIPP and local engagement. Working with LMC may be a good idea but not all LMCs have right competencies and strength to support their local GPs. As for the comment from anonymous PCT Finance Manager, it is better to find new ways of working with the right clinical inputs instead of over two decades of evidence based failures provided by PCO type of structures from non-clinical managers.

Dr Peter Patel; CEO; South Birmingham Independent Commissioners - A Pathfinder Consortium
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Anonymous, PCT,
10 Oct 2011
I think there are several key issues here.

The first is the role of the LMC. Under PCT's there was a clear role representing GP's views. However in the new world where GP's, who are members of the LMC, are running CCG's as well as being GP's make the role for the LMC harder as they cant just criticise the CCG as its decisions are made by their members. I think the LMC needs to think about how it best operates in the new world as I would suggest that it is going to have to be in a very different way.

I would agree with the earlier poster that the GP's who have come forward in CCG's are the same old faces who came forward in PbC and so far are looking to do very similar things that they have always done in PbC. This is lots of little schemes that GP's can earn an additional income from, but in the overall scheme of things are so small no one will ever be able to determine if they are acheiving what they set out to do or not as the volume of patients being seen by the services are too small. Im hoping that this years contracting round will provide the catalyst for the change in mind set that is needed if they are too be successful commissioners.

Finally micro management. All I can say is get used to it. There is no way on earth, despite the spin, that the centre is going to let go and CCG's should expect to have to comply with numerous directives from the NCB as PCT's do now. The new Health Bill makes it very clear that the power remains with the NCB upto the point where it can take over a CCG if it doesnt do what is expected.
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