Sweeping changes to local commissioning are on the horizon but GPs warn there is little clarity on what they mean for primary care budgets and contracts, finds Nicola Merrifield
Clinical commissioning groups are nearing their end but GP leaders are warning the ‘vital expertise’ of GPs could be lost in the process.
A Government white paper for a new Health and Care Bill confirms CCGs will come to an end in 2022, in major reforms designed to bring health and social care services closer together in England.
It builds on proposals launched by NHS England in November, under which budgets for general practice will be pooled with secondary care cash to create single funding pots – and new powers will make it easier to develop joint budgets with public health authorities.
This will see a ‘significant change to the working lives of GPs’, the BMA claims, with worries about local commissioned service funding many GPs rely on.
The change centres around a larger role for ‘integrated care systems’ (ICSs), which are partnerships between NHS organisations, local councils and other bodies.
This will see a ‘repurposing’ of CCGs, with the GP-led groups losing all their statutory functions. These functions will be transferred to the ICS, which NHS England says will ‘offer greater long-term clarity in terms of system leadership’.
The white paper, published on 11 February, confirms the plans: ‘Having considered the response to the NHS England consultation, the Government has concluded the allocative functions of CCGs should be held by a system level body responsible for integrated care – what we are calling an ICS NHS Body.’
But the consultation leading to the reforms revealed concerns among GPs and CCGs themselves about the plans, with warnings about the fast pace of change, and lack of mention of GPs.
The BMA wants details of how primary care commissioning responsibility will be transferred. Its consultation response says: ‘The potential changes to CCGs are a source of concern for GPs, who may face significant changes to their working lives as a consequence, and NHS England must provide complete clarity on where and to which bodies CCG powers may be transferred.’
BMA GP Committee policy lead for commissioning Dr Chandra Kanneganti tells Pulse there is a risk GPs could lose out on locally enhanced service contracts if primary care budgets are pooled.
‘Primary care budgets should not be included in ICS budgets at all. Whatever current income streams are there should always be protected for primary care.’
He adds: ‘GP practices’ income relies on the work commissioned through locally agreed non-delegated budgets.’
Keeping positive elements
The BMA’s official response also emphasises that ‘positive elements’ of CCGs should be retained in the new model, including the strong clinical voice they have helped facilitate, local decision-making and accountability to clinicians.
It says: ‘While we welcome NHS England’s commitment to retaining CCG employees, we believe further clarity is needed on where these staff and GP commissioners will be transferred and assurances that their vital expertise will be retained by local places and ICSs on a long-term basis.’ It also expresses concern over how PCNs will fit into the new model.
CCG leaders are also worried. The NHS Clinical Commissioners membership body noted ‘the pace of change was worryingly fast and the proposals effectively end the current governance arrangements’.
The plans to abolish CCGs
- The Government is putting greater emphasis on integrated care systems – partnerships between NHS organisations and local councils – and reducing the power of CCGs.
- The recent white paper states that the Government will enact legislation to create two statutory bodies in 44 ‘ICS areas’ covering England. These statutory bodies will be:
– An ICS NHS body, which will comprise a chair, a CEO and representatives from NHS trusts, general practice, plus other health bodies determined locally. The body will be named after its geographical location – for example, NHS Nottinghamshire or NHS North West London.
– An ICS Health and Care Partnership, bringing together the NHS, local government and partners such as community health providers.
- The ICS NHS body will take over the CCG’s current commissioning responsibilities.
- Under NHS England’s preferred proposal, these ICS NHS bodies will take on new functions – yet to be fully developed – and will also have the flexibility to make arrangements with providers through contracts.
NHS England. Integrating care: Next steps to building strong and effective integrated care systems across England 2021.