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Kingsland: Practices should hold commissioning budgets

CCGs should be devolving responsibility for their budgets to the level of individual GP practices, in order to enable the NHS to tackle the challenges ahead, a leading commissioning GP has claimed.

Dr James Kingsland, who is president of the National Association of Primary Care and a GP in Merseyside, said GPs should be ‘personally responsible’ for managing commissioning budgets so that they are devolved to the level where decisions were being made.

He told Pulse the Government’s original plans for ‘commissioning at scale’ were supposed to lead to GP practices holding the budgets and being personally responsible for commissioning services.

He claimed that CCGs’ work has been patchy, with some real innovation from some CCGs but with others replicating PCTs.

He said: ‘What really changes the behaviour of a cohort of general practices across the country is making them personally responsible for the budget. If patients with a low complex condition in GP opening hours goes to the A&E, there is no real incentive for the practice other than the CCG saying “did you realise this is happening?” for them to make a change to ensure it never happens again.

‘My understanding of commissioning at scale was to get CCGs devolving budgetary responsibility to where the decision was made. That decision was always at the interface with the patient, or the patient’s decision, so they will end up with an urgent care centre… CCGs don’t necessarily commission. They manage contracts, procure services but they don’t make the referral themselves.’

GPs are already doing this, he said, but there is no accountability for their decisions.

He added: ‘GPs are doing this anyway. There are thousands of GPs sitting in surgeries making commissioning decisions. They’re assessing the need of the individual and making a decision to secure the services needed. At the moment, the individual making that decision has no accountability to the budget that goes with it.’

This would help GPs remain independent contractors and repel any move to general practice become a salaried profession, he added.

‘Being an independent contractor and self-employed goes together. There is a reason for it and the efficiency of managing a population and being self-employed is all part of why the NHS is free at the point of access… General practice does 80% of the work for 8% of the funding – it is very efficient. We want to put that efficiency into the wider NHS.’

The current system is not true commissioning, he said. ‘That is what I thought was GP commissioning – anyone who thought GP commissioning was the creation of new organisations that have a few clinicians on the board, we should have just had GPs on a PCT board, that would have saved a lot of pain.’