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GPs outnumbered on nearly half of CCG boards

Exclusive: GPs have taken less than half of the seats on the new boards of CCGs, and in some parts of the country make up just a fifth of board members, a Pulse investigation reveals.

Our analysis of more than 1,300 board positions, based on data released under the Freedom of Information Act from 100 CCGs, shows practices risk being forced out of the commissioning process as CCGs struggle to keep down costs, minimise conflicts of interest and engage grassroots GPs. In some areas, financial restraints have forced CCGs to actively cut the number of GPs on their boards, despite health secretary Andrew Lansley's insistence that it is GPs who are ‘best placed' to improve NHS commissioning.

The analysis is the most comprehensive to date of the leadership of CCGs, which will assume responsibility for commissioning from April 2013. It reveals the full impact of the ‘pause' in the health bill's passage through Parliament, when CCGs were told to include more non-GPs.

Overall, responses from 100 CCGs showed that GPs held 645 out of 1,325 board positions (49%), with five CCGs unable to confirm their board's composition. Managers and finance officers accounted for some 267 positions, alongside 140 lay members, 65 nurses, 50 public health representatives, 46 from local authorities, 42 practice managers and 70 other members. In some areas, GP representation reached as high as 88%, but on 44% of CCG boards fewer than half of members were GPs. Across the country, just a third of CCGs' accountable officers were GPs.

CCGs with the lowest proportion of GPs included Nottingham West, which had two GPs (20%); Bury, with three GPs (21%); and Newcastle, also with three GPs (21%). In contrast, Medway, Sandwell and West Birmingham CCGs each had GPs in at least 75% of board seats.

Dr Guy Mansford, clinical lead and deputy chair of Nottingham West CCG, told Pulse practices in his area had agreed to cut the number of GP board members from five to two to reduce costs and the likelihood of the board being accused of having a conflict of interest: ‘With a large board there is a massive workload for governance, and innovation was just going out of the window. For small CCGs trying to live within the £25 per head budget, it is very hard to do everything.'

Bob Senior, head of medical services at RSM Tenon and chair of the Association of Independent Specialist Medical Accountants, said the £25 management allowance was a factor in the composition of many boards: ‘The economies of scale don't work so smaller [CCGs] are having to use that money judiciously, which means you can't have quite as big an involvement from GPs.'

But Dr George Rae, secretary of Newcastle and North Tyneside LMC, said the balance had swung too far: ‘If it is GP-led commissioning, the correct balance isn't GPs in the minority. There are other people who have to have input, but we must not sell ourselves short.'

GPC negotiator Dr Chaand Nagpaul said: ‘We have seen the failings of diminishing the GP presence on boards with PCTs. We need to learn the lessons and ensure the GP presence isn't being diluted.'

A Department of Health spokesperson said: ‘Beyond the core requirements set out in regulations, it is up to GP practices to decide on the composition of their CCG's governing body.'