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Can a CCG use ‘mystery shoppers’ to assess its GP practices?

A practice's primary care contract is currently with its PCT, but this will ultimately transfer to the NHS Commissioning Board when it takes over responsibility for commissioning primary care services.

It is under this primary care contract that PCTs have used mystery shoppers to assess the performance of GP practices. Areas being checked in this way include telephone answering, appointment availability, new patient registration, disabled access and customer service skills.


Although CCGs have a duty under the Health and Social Care Act to assist the NHS Commissioning Board in ‘securing continuous improvements in the quality of primary medical services', they do not have primary responsibility for the monitoring of GP practices.

The Commissioning Board may, in time, delegate this function to a CCG. This has not officially happened yet, but there are examples of it being tested. For instance, NHS London has developed ‘outcome standards' for GP practices in conjunction with Londonwide LMCs.

So the starting point is the practice's GMS contract or PMS agreement with the PCT. It will contain performance measures against which the practice will be assessed by the PCT and the NHS Commissioning Board.

The use of a mystery shopper to monitor practices against these standards would be one way performance could be assessed. 

What is important is who is carrying out the performance management.

If a CCG purports to performance manage practices in this way, it should be asked to justify the basis on which it is doing so. A CCG could contrive to do so to satisfy its general duties under the act (to promote the NHS constitution and improve the quality of services generally), but a close scrutiny of practices could be questioned on the basis that a CCG does not have direct responsibility for commissioning those services.

Remember also that a CCG is a public body and is subject to Freedom of Information Act requirements.

Requests could therefore be submitted to the CCG to ask whether mystery shoppers are being used to monitor practices in the area and, if so, the criteria they are being asked to assess.

An alternative would be to act collectively by working
with the CCG, as has happened in London, to develop agreed outcome standards against which each practice will be assessed.

Each practice will then have a clear indication of the standards it is required to achieve and can ensure it is able to meet them. 

Ross Clark is a partner at Hempsons Solicitors