Current relationships between CCGs and GP member practices are ‘fragile’, with practices feeling unable to affect CCG decision-making.
A joint study by the King’s Fund and Nuffield Trust health think tanks found that just one in five (20%) of GPs without a formal commissioning role felt they could influence the work of their CCG if they wanted to. This was a reduction since 2014, when 35% thought they could.
Their survey of GPs and practice managers found that CCGs ‘have secured better GP engagement than previous forms of commissioning’, with over 70% of member practices at least ‘somewhat’ engaged with the work of their CCG.
But GP practices in six CCGs followed by the think tanks since their creation felt that there had been little or no change in the quality of care in general practice following the introduction of CCGs in 2013.
Analysing the reasons behind the situation, the report said that ‘a lack of resources and autonomy are making it difficult for CCGs to effectively engage with their GP members and the pool of GPs currently interested in commissioning work is limited’.
The report said: ‘Efforts to involve GPs in commissioning decisions are fragile and being put at risk by a loss of autonomy among CCGs.
‘Leaders from all of the CCGs that we have been working with highlighted the risk that top-down direction and control from NHS England would crowd out GPs’ engagement with the commissioning process.’
The report recommended that the Department of Health and NHS England provide CCG leaders with more training, promote commissioning as a career option and set out more clearly the roles of CCGs in developing new general practice care models.
King’s Fund policy fellow Ruth Robertson said: ‘Our research shows that while CCGs have made good progress in engaging GPs in local commissioning decisions, there remain significant barriers to effective clinical engagement and to translating this into improvements in quality of care.
She added that the ‘NHS must now build on CCGs’ achievements and do more to embed clinical involvement in planning decisions across the health care system’ – including ‘proporly supporting’ GP commissioners within CCGs but also making sure they have a stronger voice in the NHS England ‘vanguard’ new models of care programme and the ongoing work to set out regional sustainability and transformation plans (STPs).
She said: ‘As well as properly supporting GP commissioners within CCGs, this means ensuring that GPs and other clinicians have a strong voice in the sustainability and transformation planning process and in the vanguards’.
NHS Clinical Commissioners co-chair Dr Amanda Doyle said: ‘As a CCG leader and a GP myself I recognise the challenges and pressures that come with balancing both roles, and we know there is more to do to make sure even more GP colleagues and other clinicians feel able to actively participate in the clinical commissioning process.’
