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CCGs ramp up performance management of GPs as thousands sign inter-practice agreements

Exclusive: Thousands of practices have already signed inter-practice agreements with their CCG, as the new commissioning bodies move to tighten their performance management of GPs, a Pulse investigation reveals.

Papers obtained under the Freedom of Information Act from 128 CCGs show 54 already have an inter-practice agreement in place, while 31 are in the process of developing the controversial agreements.

Many of the agreements place GPs under intense scrutiny, with some benchmarking practices on everything from breastfeeding to Choose and Book use. But despite this, 1,391 practices across the sample of 54 CCGs – some 91% - have already signed the agreements.

The findings come as the GPC issued new guidance advising practices not to sign agreements that include performance management measures or exclude LMCs. Almost two-thirds of the agreements seen by Pulse contain reference to performance managing practices, while just 38% mention the role of the LMC.

New guidance released last week by the NHS Commissioning Board states CCGs will not hold responsibility for performance managing against the contract – but muddied the waters by asking CCGs to ‘provide evidence of benchmarking on primary medical care outcome indicators across member practices'.

All CCGs are required to develop constitutions for their member practices to sign from April 2013, but Pulse's investigation shows many have developed detailed agreements long before they become statutory bodies.

Examples include Coastal West Sussex CCG's agreement, currently being updated, which asks practices to produce an annual portfolio of evidence ‘to demonstrate a range of competencies and qualities across all services'. Practices must provide monthly financial reports and attend quarterly face-to-face reviews, and could be removed if they are not meeting standards.

C4 CCG in Kent, whose agreement for 2011/12 is also currently being updated, requires practices to review prescribing and referral patterns ‘as a minimum, on a monthly basis', while an agreement drawn up by NHS Mid Essex CCG requires practices to attend quarterly meetings to identify issues, with the remit to take ‘remedial action' if necessary.

Dr Una Duffy, chair of Bedfordshire and Hertfordshire LMC, said the draft inter-practice agreement drawn up by Bedfordshire CCG included a scorecard rating of practices
on measures including life expectancy, breastfeeding, BMI checks and Choose and Book use.

‘The CCG put in points about "promoting excellence", which is a euphemism for performance managing practices,' she said. ‘Many are unreasonable and we don't think practices should have to sign.'

Bedfordshire CCG said the agreement was based on the views of local practices and it was willing to meet with the LMC to discuss any outstanding concerns.

Dr Chaand Nagpaul, a GPC negotiator who drew up the GPC's latest guidance, said practices should veto agreements that contained performance management clauses. He said: ‘It is vital that practices exercise their right of veto.'