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NHS England considering contract changes to allow CCGs to co-commission GP practices

NHS bosses are currently reviewing what new ‘contractual elements’ are needed to enable CCGs to jointly commission primary care with area teams, revealed NHS England’s deputy director.

Dr Mike Bewick said the review would ‘not necessarily’ involve changing existing contract models, but that NHS England was looking at making it easier for CCGs to reorganise primary care.

The comments are the strongest signal yet that NHS England is serious about co-commissioning of primary care by CCGs and area teams.

But they are likely to be opposed by the BMA who has said that rejected proposals because of the significant legal risk posed to commissioning GPs and to avoid GPs having to performance manage their own contracts.

Speaking at a Londonwide LMCs conference yesterday, NHS England deputy medical director Dr Mike Bewick said the organisation of primary care was being ‘revisited’ in its ‘Call for Action’ review.

He said: ‘That does not necessarily mean changing contracts, but it could mean changing contracts and there will be different contractual elements put forward by [NHS England’s national director for commissioning development] Ros Roughton and her team to look at how we can develop primary care.’

He said that the review will focus on co-commissioning: ‘CCGs do not commission care that you deliver. One of the things we can do from the centre – and there is a signal we can do this, as [NHS England chief executive] David Nicholson has said we can – is look at how we co-commission primary care with CCGs. Why would you not want to involve the experts who run a service in designing the service?’

‘What we don’t want to do is compromise you by putting you in a position where you are contracting with yourselves – that would not hold politically and we will get lots of other regulators involved if we do.’

Ideas to hand more of the primary care budget to CCGs have been widely floated over the past year, including by NHS England chair Sir Malcolm Grant. Professor Malcolm Grant said that the perception of conflicts of interest remained the biggest obstacle, but if this could be overcome, then he would consider CCGs commissioning ‘aspects or… all of primary care’.