Exclusive Almost half of CCGs have opted to take on full responsibility for commissioning general practice, including performance managing practices and potentially introducing local incentive schemes to take the place of QOF, but GPC have criticised commissioners for failing to sufficiently consult with member practices.
The first deadline to apply for ‘delegated commissioning’ – Level 3 co-commissioning, the highest level – passed at noon on Friday, and Pulse has discovered that 42% of the 77 CCGs that provided information applied to take this on.
A further 30% of CCGs said they will apply for Level 2 co-commissioning by the 30 January deadline, which allows them to jointly commission general practice alongside area teams.
The investigation also revealed that the majority of CCGs applying to take on greater responsibility did not ballot member practices and had only garnered support at an open meeting, a move GPC said ‘falls far short’ of what it has called for.
This is the first indication of the extent to which CCGs will take over the commissioning of primary care from NHS England after chief executive Simon Stevens made co-commissioning a priority upon taking up his role last year.
CCGs were invited to submit expressions of interest for commissioning primary care in June 2014 and subsequent guidance unveiled by NHS England in November outlined the extent to which CCGs would be allowed to commission primary care, including the monitoring of contracts, offering alternatives to directed enhanced services and introducing local QOF replacements.
The deadline for applying for the highest level of commissioning passed at noon on Friday, and Pulse found that 32 of the 77 CCGs had applied for this.
Pulse has already reported that 12 CCGs had said they would use this responsibility to explore the possibility of replacing the national QOF with a local scheme.
Only 11% of CCGs wanted to take on Level 1 commissioning, which would allow them greater involvement in area team decision making, while 17% were still deciding.
However, a number of CCGs who were not applying for Level 3 commissioning this time round said they had plans to take delegated responsibility in the future when there was clearer information available on how this will work in practice.
Pulse also asked the CCGs whether they had put the decision out to a full vote of members, since opting to take on full responsibility or joint responsibility for commissioning primary care would mean making a significant change to the CCG constitution.
The investigation found that 25 out of 55 CCGs going for level 2 or 3 have not balloted members, 22 had done so and eight did not specify.
The GPC has advised that CCGs should put the decision about co-commissioning out to a full ballot of members.
Chair of the GPC contracts and regulations subcommittee Dr Robert Morley said: ‘Support in an open meeting falls far short of what the GPC guidance has called for – i.e. a proper transparently conducted ballot of member practices. [A] fundamental decision such as this which will involve significant change to the constitution [and therefore] must be in line with what the constitution stipulates.’
It comes as Kent LMC vowed to block any attempt by local CCGs to take joint or delegated commissioning responsibility for general practice, with Pulse’s new investigation revealing all Kent CCGs are now only applying for greater influence in decision making.
The GPC has advised that it resists delegated commissioning responsibilty where this includes member practices being contractually performance-managed by colleages.
It comes after Pulse reported that two thirds (66%) of CCGs expressed in their initial submission from June last year that they wanted full delegated primary care commissioning, including a third willing to take on contractual performance management.
CCG co-commissioning plans, and what they mean
9 (11%) CCGs have said they will take on Level 1 commissioning – Greater involvement, CCGs collaborating closely with their area teams
23 (30%) CCGs have said they will take on Level 2 commissioning – CCGs assuming joint commissioning responsibilities with their area team
32 (42%) CCGs have said they will take on Level 3 commissioning – Delegated commissioning, CCGs assuming full responsibility for commissioning primary care services
13 (17%) CCGs have not yet decided which level to go for
Source: Pulse media enquiry receiving 77 responses