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LMC vows to block CCGs’ attempts to commission primary care



Exclusive An LMC has voted to block any attempts by its CCGs to co-commission primary care over fears that practices would be subject to local performance management, Pulse has learnt.

Kent LMC held an urgent meeting and voted against the eight CCGs in the county taking on extra commissioning responsibilities that could see them introducing local QOF schemes, administering the GP contract and making decisions on opening new GP practices.

Local leaders expressed concerns that it could lead to an ‘inconsistency’ when dealing with breaches of contracts, while the lack of a clinical majority on co-commissioning bodies would lead to a ‘return to the days of PCTs’.

It comes as a Pulse survey has revealed that only around one in four GPs has been consulted about CCG plans for co-commissioning.

But the LMC’s intervention is the first reported instance of local GPs putting blocks in place for CCGs to commission primary care.

NHS England has given CCGs until January to apply for co-commissioning powers, but some GPs have previously expressed concerns that their contracts will be renegotiated locally.

Pulse revealed last month that a third of CCG leaders want new powers to performance manage the GP contract, and Kent LMC co-medical secretary Dr John Allingham said that this was a major concern for local GPs.

He said: ‘We are opposed to level three commissioning [full co-commissioning powers]. The problem with delegating to a local level is that your peers are sitting in judgement on your contract. We think it’s better if contracts like that are held centrally. If you delegate it down then there will be an inconsistency of approaches in dealing with breaches. It becomes more complicated.

‘The co-commissioning agenda requires a joint committee to be set up by a CCG and the area team, but we are concerned by plans for a lay or executive majority. This means that clinicians will be in a minority regarding decisions. It’s like a return to the days of PCTs. Doctors will be blamed for decision that they do not have the power to control.’

He said that the LMC’s intervention will be expressed at CCGs’ membership meetings.

Dr Allingham said: ‘This is not exactly a formal consultation but we have expressed our concerns. Most of our CCGs are holding or have held membership meetings to discuss this. To move to co-commissioning will require support from the majority of practices, and voting varies. To date we are not aware of any of our CCGs actively changing their constitutions. This may change.’

A spokesperson for the CCGs in the region said NHS West Kent CCG has agreed to opt for greater involvement in 2015/16, while NHS Dartford, Gravesham and Swanley CCG, NHS Swale CCG, NHS Medway CCG and NHS South Kent Coast CCG have not yet taken a final decision on which model they wish to adopt. NHS Thanet CCG, NHS Ashford CCG and NHS Canterbury and Coastal CCGs were unable to respond at time of publication.

It comes as a Pulse survey of 504 respondents revealed that some 222 GPs said they had not been asked for their views on whether their CCG should apply to co-commission GP services.

GPC deputy chair Dr Richard Vautrey said: ‘It’s simply not good that GPs are not being consulted. It’s imperative that CCGs both inform members and give opportunities to discuss the way forward about what level of commissioning is being proposed. Otherwise we’ll go back to the old days when senior managers just tell everybody what to do.’

The Pulse survey also shows that about a third of GPs – 175 – believe their CCG could do a better job of commissioning general practice than NHS England, while 84% of respondents said they did not have faith in NHS England being able to commission general practice efficiently.

Meanwhile, just 30% of CCGs’ five-year strategic plans have been agreed by ‘all parties within the health economy’, according to a survey of CCG finance directors by the Healthcare Financial Management Association. 

The data relates to responses by 64 CCGs. Most plans were partially agreed, but 5% of CCG plans were ‘not agreed at all.’

Survey results

Were you consulted by your CCG on whether it should apply to ‘co-commission’ GP services?

Yes: 27%

No: 44%

Don’t know: 29%

Do you think CCGs would do a better job of commissioning general practice than NHS England?

Yes: 35%

No: 37%

Don’t Know: 28%

Do you have faith in NHS England being able to efficiently commission general practice?

Yes: 4%

No: 84%

Don’t know: 12%

The survey was launched on 10 September 2014, collating responses using the Survey Monkey tool. The questions covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 560 GPs answered these questions.