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Commissioning groups 'bullied' to alter their structure

By James Brown | 29 Nov 2011

Many clinical commissioning groups are being ‘coerced or bullied' by NHS managers into structures that conflict with what is best for their local populations, finds a new survey.

The survey of 257 ‘pathfinder' CCGs revealed that 60% of respondents answered yes to the question ‘Do you feel as if your CCG is being coerced or bullied to alter the way you are setting it up, in ways that conflict with what you feel would benefit your local population?'.

The Clinical Commissioning Coalition – formed by the NHS Alliance and the NAPC - conducted the survey and says the bullying appears to be coming from the existing NHS management infrastructure of PCTs and SHAs.

The results of the survey, which received 67 respondents, come in light of a Pulse report on the NHS Midlands and East SHA shutting down a single-practice CCG despite its ‘excellent work' because it was ‘not permitted' under the health bill.

Dr Michael Dixon, a GP in Devon and a leader of the Clinical Commissioning Coalition, said: ‘We've heard too many reports that CCGs are being told by the current system managers that they must be created in specific ways.'

He added: ‘In a significant number of cases, this seems to cross the line into unacceptable pressure in the form of bullying or coercion'.

CCG mergers are likely to have to merge after the Government's 2012/13 NHS Operating Framework, published last week, determined that CCG management allowances would be set at £25 per head.

READERS' COMMENTS

Anonymous, PCT,
30 Nov 2011
Sorry guys but this is economic reality rather than the brave new world spun by Lansley last year. Call it economies of scale or whatever but small organisations are likely to be very expensive compared to their larger brothers.

We will end up with PCT size CCGs backed up by SHA size admin structures.


PCT Finance Manager
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Peter Swinyard, GP Partner,
30 Nov 2011
Typical that a PCT reader wishes to recreate PCTs. Natural clinical communities must be encouraged to see if they can make a smaller CCG work - probably by sharing some of their necessary audit and oversight functions. Models like Liverpool which wanted 3 CCGs with a joint working agreement to provide geographical coverage must be allowed to try to flourish - if we do not encourage diversity we lose innovation which would be a tragedy - and lose the enthusiasm of the best GP leaders, which would be more of a tragedy.
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Anonymous, PCT,
30 Nov 2011
Peter,

I don't want to recreate PCTs!!!! I ask you to just do the maths - the more smaller organisations, the more meetings of GPs, the more discussions about next year's contract, the more reports required, the more reconciliations, audits, etc etc

Yes there are economies that can be achieved by creating large scale admin support but this only goes so far. Small may be beautiful but not practical.

PCT Finance Manager
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Anonymous, Manager,
30 Nov 2011
I can't believe any GPs are being bullied by NHS managers, it would surely be a first. Most of the time GPs are too busy being God's gift to the world )or so they say!)
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Anonymous, Manager,
30 Nov 2011
Sorry Dr Dixon I don't know if you have heard but the aim is to reduce management costs. If it costs 4 times as much to have a GP at a meeting than a manager due to locum cover costs, then you can only afford a quarter as many meetings, or a quarter as many management organisations.
Add in 40% cut in management costs and that takes you down to a tenth.

No amount of your drip drip publicity strategy promoting clinical commissioning will change those numbers!!!
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Anonymous, Sessional/Locum GP,
30 Nov 2011
The idea that managers would relinquish control to doctors was always far-fetched without direct ministerial intervention. Likewise the idea that they would allow their bureaucratic empires to be dismantled.
Some GPs have been involved with commissioning before. It was called fundholding, and no, it did NOT consist of endless meetings and paperwork. Audits were set up to run themselves. Clinical work was more efficient and large savings were made for the NHS. Small can be efficient if not stuffed out with managerial dead wood.
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Anonymous, Manager,
01 Dec 2011
Yes barely a day goes by without wanting to perpetuate my bureaucratic empire!!!

What a disturbingly naive attitude to hear from a professional.
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Marie-Louise Irvine, GP Partner,
01 Dec 2011
I am a GP and I feel bullied. But not by PCTs. I feel bullied by the ConDem government which is forcing GPs to become members of CCGs. There will be no alternative and practices that are not in CCGs will lose their contracts. And even though it is not law yet practices have felt compelled to join into shadow CCGs so as not to be left out in the cold and also so as to fill the void left by the decimation of PCTs. So I feel bullied - really bullied. And its time to fight back! What if practices disengaged from CCGs? What percentage would have to disengage to make the whole project unviable? If enough of us did it together we could not all lose our contracts at the same time as this would be too damaging to the delivery of primary care and political suicide for the government. I want to start a discussion on the idea of disengaging from CCGs. I would be interested to hear others' thoughts on this.
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Marie-Louise Irvine, GP Partner,
01 Dec 2011
The research shows that fundholding did not create large savings for the NHS and the managerial costs were higher.
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