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Revealed: How CCGs are railroading practices into signing constitutions

Exclusive: CCGs are attempting to force through constitutions and rush practices into signing unsuitable agreements within a matter of weeks, according to a damning new GPC dossier.

The file of complaints – gathering evidence from eight separate LMCs and sent to ministers as part of an escalating row over constitutions – claims GPs are being invited to meetings managers know they cannot attend, and are facing tight deadlines to sign documents with warnings that the CCG may fail authorisation if they do not.

GPC negotiators fear GPs are being bullied into signing constitutions that fail to recognise the representative role of LMCs and contain potentially draconian performance management clauses – and are warning practices not to sign them without careful scrutiny.

Pulse understands that in one area not covered by the dossier, GPs have refused to sign a constitution because it contains a gagging clause which would block them from making ‘any public statement or disclosure concerning the CCG or any members without prior written consent’.

The dossier obtained by Pulse shows:

  • Practices are being pressured into signing constitutions at short notice, with some given only three to four weeks to consider ‘significant documents’
  • Practices have been invited to CCG meetings ‘that knowingly start before the end of evening surgery’
  • One CCG elected two board members unopposed ‘through a simple show of hands in a closed meeting consisting of the old PBC consortium’
  • An LMC was told its position on the CCG would be ‘limited to that of a layperson’ – a move the GPC claimed ‘essentially alienat[ed] the whole of the local GP profession’
  • One CCG is insisting all GP representatives must work at least four sessions a week
  • One CCG has claimed it is under pressure from the NHS Commissioning Board authorisation team to use a template constitution instead of a shorter version reflecting local consultation.

The dossier comes a week after Pulse revealed CCGs are struggling to involve GPs in their decision-making, with 360-degree practice surveys showing many GPs feel frozen out by the new groups.

GPC negotiator Dr Chaand Nagpaul told Pulse the rollout of constitutions was like ‘mis-selling of insurance policies in the 1970s’.

‘CCG boards are rushing GPs into signing them under duress by a certain deadline, with the threat that the CCG won’t get authorised,’ he said.

Dr Richard Vautrey, GPC deputy chair, said ‘every practice’ should read its proposed constitution carefully.

Dr Andrew Mimnagh, chair of Sefton LMC, said a CCG constitution on his patch was now in its third draft after being rejected as ‘overly intrusive’: ‘It was old-school NHS management – nothing about membership organisation. The whole thing has been a total mess nationally.’

Dr Clive Shaw, chair of South Sefton CCG, said there had been ‘real involvement and debate’.

Dr Una Duffy, chair of Bedfordshire LMC, said the LMC had initially been excluded from local draft constitutions, and had only been able to negotiate acceptable agreements with the help of lawyers. She said: ‘It has taken a lot of work. The problem has been things imposed from the top.’

A spokesperson for the NHS Commissioning Board Authority said: ‘The NHS Commissioning Board Authority produced a model constitution, which can be tailored to local use, to help CCGs with this key part of their governance arrangements.

‘To achieve full authorisation, CCGs need to evidence that their member practices are signed up to their constitutions, but we have been flexible as to how this is done to reflect local circumstances.

‘We survey member practices in the 360 survey to see if they have been engaged in the development of the CCG and the constitution and the LMC can respond to the 360 survey if they are chosen as a respondent by the CCG.’