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Give CCGs the budget to commission GPs, says Dixon



CCGs should be handed the full primary care budget as NHS England are failing to invest more in GP practices, a leading commissioning expert has urged.

Speaking to Pulse in a personal capacity, Dr Michael Dixon, interim president of NHS Clinical Commissioners, admitted the idea was ‘controversial’, but that he had recently come to think that there was no alternative to develop a primary care-led NHS.

But his ideas were rejected by the GPC, who said it would result in conflicts of interest and mean GPs in CCGs would have to performance-manage their own contracts.

Dr Dixon told Pulse: ‘It’s a controversial and radical proposal and originally I wasn’t in favour of it, as it could set up conflicts of interest for GPs.

‘However, I now think there’s no longer any alternative, because NHS England are not able to perform on this.

’They’re having a great deal of difficulty in covering primary care and there’s not sufficient local sensitivity. We need much greater fluidity between primary care and CCG budgets. This is holding up a lot of good work that could be done by CCGs.’

PCTs commissioned both hospital services and primary care at a local level until April this year but NHS England took over commissioning primary care centrally to avoid CCGs having a conflict of interest as provider and commissioner.

Dr Dixon said there had been a hiatus in the development of primary care since NHS England took it over which, coupled with underfunding in previous years meant GPs weren’t able to provide the service they wanted.

He said: ‘A primary care-led NHS has been a joke over the past few years and history tells us we´ve done badly in the past. Last year, secondary care budgets grew by 1.4% while primary care shrank by the same amount. ‘There’s been a 50% increase in the number of hospital specialists in the last 10 years compared with a 4% fall in the number of GP partners. The movement has been going badly in the wrong direction.’

But Dr Richard Vautrey, GPC deputy chair said: ‘GPC does not support CCGs being given the budget for commissioning general practice. CCGs were not given commissioning responsibility for general practice at the time of the health bill reforms for good reason, to avoid conflicts of interest and avoid GPs in CCGs having to performance manage their own contracts.’