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CCGs to take over majority of GP budget, under NHS England proposals

GP practices could see the majority of their funding – including global sum, QOF, enhanced services and premises – devolved to CCGs within a year, according to a timetable released by NHS England.

CCGs have also been asked to retender co-commissioning bids by 6 January, which more than nine out of ten CCGs submitted an interest in, after complaints their expressions of interest were ‘incorrectly categorised.’

A ‘Proposed next steps towards primary co-commissioning’ overview, released last month gives details on what exactly GP commissioners could take responsibility from April next year.

It states that the functions ‘most suitable for full delegation’ by CCGs could include GMS and PMS contracts; enhanced Services (GP and Pharmacy, “LES and DES”); property costs; and QOF (for full delegation only).

It states: ‘We have not detected an appetite in CCGs to take on revalidation and performer’s lists, and many CCGs also believe that individual and practice performance management aspects of contract management should not be open for delegation.’

And it calls for feedback on whether further elements should be excluded or added.

Under the plans for co-commissioning primary care, announced by NHS chief Simon Stevens in May,  CCGs were able to submit plans for taking on added responsibility across three broad categories.

This includes giving CCGs greater involvement ‘in NHS England decision making’, and joint commissioning, where legislation was reformed to allow joint CCG, area team with a pooled budget.

The final option is for ‘delegated commissioning’ – the options outlined above – with CCGs commissioning primary care on NHS England’s behalf, was described by GP leaders at the annual LMCs conference as ‘the ultimate poisoned chalice’ for GPs.

The overview states this: ‘offers an opportunity for CCGs to assume full responsibility for commissioning primary care services’.

It adds: ‘However, for legal reasons, the liability for primary care commissioning remains with NHS England. Therefore NHS England will require assurance that its statutory duties are being discharged effectively.’

And explains that: ‘it is likely that co-commissioning will lead to an increased number of conflicts of interest for CCG governing bodies and GPs in commissioning roles.’

And says work with the BMA and RCGP is underway to handling these conflicts.

Dr Andrew Mimnagh, a GP in Liverpool and member of South Sefton CCG echoed this concern saying he felt the plans could be a way of NHS England divesting its more difficult responsibilities.

He told Pulse: ’There is brilliance in this chaos. By coincidence last week we had a full CCG away day, we had the entire CCG staff in a room, a reasonably small one and everyone in there is about a quarter of the workforce of a PCT previously.

‘So you’ve gone through a rearrangement that’s dropped it down, and the actual dynamic at the minute is that CCGs are being offered the “business as normal” activity of a PCT with a quarter of the staff.’

GPC deputy chair Dr Richard Vautrey told Pulse that co-commissioning posed two problems, in conflicts of interest and how the extra work CCGs take on would be resourced.

He told Pulse: ‘What we appear to be heading towards quite rapidly is a PCT-like organisation, so the conflict of interest issue would have to be resolved as part of that. The bigger question for CCGs is, have they got the capacity and resources to handle this?’

‘Because NHS England has struggled financially, and if it is simply going to pass responsibility but not any resources or personnel to deliver this, then that creates an added burden for CCGs, when they’ve got plenty of things to be getting on with, without this extra work and no resources to deal with it.’

‘With a national contract, that works because of economies of scale in the way that England as a whole, or the UK as a country can utilise that resource to manage a national contract.’