NHS England wants ‘as many CCGs as possible’ to start commissioning general practice by 1 April 2015, in a radical move to devolve responsibility for managing primary care to CCGs.
In guidance issued today, developed alongside NHS Clinical Commissioners, it has said CCGs must choose how much responsibility they want for primary care by January 2015, including options to have greater involvement in NHS England decisions, to jointly commission services with local area teams, or even take full responsibility for GP services.
NHS England said that CCGs will be supported to move to co-commissioning by April, subject to the CCG not being in ‘special measures’.
Under the new guidelines, any CCGs wishing to take responsibility for commissioning primary care on their own would not be able to cherry pick responsibilities, and would take full control of:
- GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);
- Newly designed enhanced services (‘local enhanced services’ and ‘directed enhanced services’);
- Design of local incentive schemes as an alternative to the QOF;
- Decision making on whether to establish new GP practices in an area;
- Approving practice mergers; and
- Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).
The document said: ‘The aim is to support as many CCGs as possible to implement co-commissioning arrangements by 1 April 2015. Unless a CCG has serious governance issues or is in a state akin to “special measures”, NHS England will support CCGs to move towards implementing co-commissioning arrangements.’
It comes after Pulse reported last that two thirds (66%) of CCGs expressed in their initial submission from June this year that they wanted full delegated primary care commissioning.
As previously reported, the new arrangements will allow CCGs to design local incentive schemes as an alternative to QOF and DESs, which will require them to ‘consult’ with LMCs, but would remain voluntary for practices.
NHS England will remain responsible for administration of practice payments and practice list management, as well as individual GP performance management, performers list management and revalidation.
CCGs or joint committees will also be unable to vary any nationally determined elements of GMS, PMS or APMS contracts.
But NHS England warned CCGs: ‘There is no possibility of additional administrative resources being deployed on these services at this time due to running cost constraints.’
The guidance also stated that CCGs will need to change their constitutions in order to take on commissioning of primary care, and they will be able to take on more or less responsibility in the future.
NHS England national director of commissioning strategy Ian Dodge and NHS Clinical Commissioners co-chair Amanda Doyle said in a joint foreword to the document that although they ‘are confident that co-commissioning – or delegation to CCGs – is in the best interest of patients’, it is up to every CCG to decide how to respond to the invitation.