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Nicholson signals U-turn on recruitment of local consultants to CCG boards

Exclusive: CCGs may be allowed to recruit local consultants to their boards, after the head of the NHS Commissioning Board signalled he was ‘very open’ to relaxing the legal stipulation that they must come from outside the area.

The rethink on the regulations surrounding CCG board structure comes after a Pulse investigation found only 7% of CCGs has appointed a secondary care doctor to their governing body to date.

It also comes as the NHS Commissioning Board told Pulse that CCGs will not be blocked from authorisation if they have not found a suitable consultant to sit on their board.

The move comes despite regulations laid before Parliament last month saying that every CCG board must have at least one consultant, but that they cannot be anyone who ‘provides any relevant service to a person for whom the CCG has responsibility’.

The stipulation was designed to prevent conflicts of interest, but has created obstacles for CCGs in sourcing suitable candidates to sit on their boards, with the GPC saying the restriction ‘didn’t make logical sense’.

Pulse revealed last week that only 36 out of 100 CCGs surveyed had reserved a position for a secondary care doctor– with only seven of these positions currently filled.

It meant the vast majority of CCGs face a scramble to appoint a consultant in the next few months, with the authorisation process set to begin in September.

Speaking to Pulse, David Nicholson, chief executive of the NHS Commissioning Board, said he was open to a rethink on the restrictions.

He said: ‘I think what we need to do is we need to go through this round of recruitment and then take stock.

‘I’m very open about thinking about what the alternatives might be if we simply can’t get the quality.

‘I don’t think CCGs should appoint people just for the sake of it. I think we should get the best people we can. If that means we might have to look in the local communities in the future then I’m open to that discussion.’

The NHS Commissioning Board said the presence of a consultant was legally required on boards, but CCGs could be authorised with conditions.

A spokesperson said: ‘A CCG cannot be fully authorised until it meets this and other requirements concerning governing body composition.

‘However, if at the point of authorisation a CCG does not have a suitable candidate for this role it could be authorised with conditions. These conditions would then be discharged once the CCG was fully compliant.’

He added that if CCGs were finding it too difficult to appoint a secondary care consultant from outside the CCG’s boundaries, they would be open to a discussion about alternatives – such as appointing consultants from the local area.

He said: ‘Recruitment is in its early stages but clearly, if problems with such recruitment remain a widespread issue, the NHS Commissioning Board Authority would need to consider its response.’

Dr Chaand Nagpaul, a GPC negotiator, said this was a ‘sensible’ way forward.

He said: I’m glad common sense is prevailing belatedly. This was always an unusual and logistically difficult requirement.

‘Consultants from outside won’t understand the local context and won’t necessarily make the best decisions.’

Dr Charles Alessi, NAPC chair, said it shouldn’t matter if the consultant comes from inside or outside the CCG’s borders.

He said: ‘The most important thing is to have the right person. Not a consultant by virtue of a consultant. This is about the person not about what tribe they come from.

‘The real issue is conflict of interest. If the consultant understands that there are competing priorities and that they have to balance these out rather than thinking about their own narrow speciality, it matters less if they’re from inside or outside.’