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Editorial: GPs must sit in the driving seat

With just nine months to go until the demise of PCTs, the structure of Andrew Lansley’s brave new NHS is gradually taking shape – and Pulse’s investigation this week puts names and faces to the leaders of the revolution.

While pretty much every practice is now a signed-up member of a CCG, the mere fact of membership does not – despite ministers' protestations to the contrary – equate to any particular enthusiasm for the NHS reforms. Nor does there appear to be a groundswell of GPs desperate to take on a leadership role, given that two-thirds of GPs elected to a CCG board faced no competition.

Instead, grassroots GPs seem mostly happy to keep their heads down and let CCGs just get on with it. And so our analysis of more than 1,300 board positions across 100 CCGs offers a fascinating snapshot of commissioning's emerging officer class.

There is a stark gender divide, with women clearly under-represented. The Department of Health's insistence that every board should include a hospital consultant does not appear to have translated into reality – just seven CCGs surveyed had one. Likewise the GPC's demand for CCGs to hold fresh elections before assuming commissioning responsibility – around one in three will do so.

But most striking of all is the extent to which GPs appear to be losing their grip on the organisations they were meant to lead.

Overall, GPs make up less than half of CCG board members, and in some areas are outnumbered four to one by managers, nurses, councillors and others.

Alarmingly, some small CCGs have actually been forced to shed GP board members on the grounds that they are simply too expensive to backfill.

It is right that other disciplines should be represented, and this time last year the NHS Future Forum acknowledged as much when its report recommended the term ‘GP commissioning' should be replaced with ‘clinical commissioning'.

But that report also warned against compulsory board places for consultants, and added: ‘We recognise the unique role of GPs who are tied in through their practice contracts to commissioning consortia, and who therefore will have overall accountability for the decisions made.'

With hindsight, the NHS Future Forum was spot on. If commissioning is to work, it must not be simply about a minority of keen GPs redrawing a few care pathways. CCGs must not water down the power of GPs to the extent that they end up recreating PCTs.

Ultimately, it is GPs who will be held responsible for the success or failure of their CCG, contractually, financially and in the public eye. And, of course, beyond commissioning CCGs will wield enormous power over their constituent practices – over prescribing, referrals and performance management.

GPs should be keen to ensure they and their colleagues retain the balance of power. If they let it slip, they may regret it.

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