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NHS England chair hints at CCGs commissioning primary care



The chair of NHS England has given the strongest indication yet that the body will consider giving CCGs control over the commissioning of primary care.

Speaking at the Westminster Health Forum on the future of the NHS today, Professor Malcolm Grant said that the perception of conflicts of interest remained the biggest obstacle, but if this could be overcome, then he would consider CCGs commissioning ‘aspects or… all of primary care’.

NHS England deputy medical director Dr Mike Bewick said last month it was a ‘waste’ for commissioning groups to have no responsibility in commissioning primary care, laying the ground for a significant shift in responsibility from NHS England to CCGs.

However, coming from the chair of the body, Professor Grant’s statement gives the strongest indication that NHS England is considering giving CCGs a greater role in commissioning primary care.

Earlier in the day, Dr Michael Dixon – the chair of the NHS Alliance – said the current situation was ‘bonkers’, and reiterated his call for CCGs to be given control of primary care commissioning.

Responding to a question from Pulse, Professor Grant said: ‘I heard Mike Dixon referring to this and I think the word “bonkers” came out.

‘It is something we do need to reflect on because the relationship between CCGs and primary care is an extraordinarily intricate one.’

However, he added that the issue of conflicts of interest had to be resolved.

He said: ‘There is the concern that Mike [Dixon] raised in that the world sees COI everywhere and every board operating in the public domain has to be scrupulous about hadniling COI. If you could come up with a model that would ensure that CCGs could commission aspects – or, indeed, all – of primary care and completely avoid the attribution of conflicts of interest, I would be very interested in it.’

Dr Dixon earlier said: ‘It is completely mad to have primary care commissioning separate from commissioning of local and hospital services as we have at present. We’re asking CCGs to redesign care, to move services from hospitals to communities, yet we are binding them by hand and foot by saying that primary care commissioning with NHS England. It is completely bonkers.’

‘Against that hypothesis comes the hows of conflict of interest. Rubbish. It is very easy to create systems of governance that overcome conflicts of interest. Very easy to demand from your providers, whether they are GPs or anyone else, that they have transparency.’

Professor Grant also claimed that the capitation funding model was a form of conflict of interest in itself.

He said: ‘There are of course conflicts of interest within primary care and the organisation of GP surgeries already, because the capitation fee allows GPs to do as much or as little in some respects as they might wish. Most GPs are conscientious in what they do.’

Last month, Pulse revealed that one in five CCG clinical board members had a financial interest in a provider that holds a contract with the CCG.