‘No clear evidence’ GP commissioning led to improvements, says Government

There is ‘no clear evidence’ that GP-led commissioning led to improvements, the Department of Health and Social Care (DHSC) has said.

GPs will be able to instead ‘focus’ on areas ‘where they add most value’ when CCGs are abolished, it added.

But GP commissioners said the Government’s assessment was based on 2014 data, and that things have moved on ‘significantly’ since then.

In February, an NHS white paper revealed plans for CCGs to be replaced with new integrated care systems (ICSs) – bringing an end to GP-led commissioning.

And in an ‘impact assessment’ for the new Health and Care bill that will enshrine the reforms in law, published earlier this month, the DHSC said that the changes present both ‘potential benefits and risks ’.

The document said: ‘The abolition of CCGs, and the greater involvement of a wider range of providers and local authorities in resource allocation decisions, brings a formal end to GP-led commissioning at system level.

‘There was no clear evidence that the creation of CCGs as GP-led organisations had led to tangible improvements in commissioning, although both clinical and managerial respondents were enthusiastic about the role played by local clinicians.’

It added: ‘Therefore, a potential benefit of the proposal may be that clinicians can better focus their resources where they add most value.’

However, it said that there ‘may be benefits’ from local clinician involvement in the ‘design and commissioning of primary, community and integrated care services, and, in fostering better relationships between commissioners and local providers’ due to ‘variation across the system’.

‘A risk of this proposal would be that the potential benefits of GP-led commissioning are lost’, it added.

But the DHSC said that the expectation that ICSs will ‘involve clinical expertise at every level’ will ‘mitigate this risk’.

It added: ‘This proposal allows clinicians the flexibility to target their efforts more usefully.’

Under the bill, two statutory bodies – an integrated care board and an integrated care partnership – will be formed, with only one GP being required on the board, according to recent NHS England guidance.

NHS Clinical Commissioners (NHSCC) – part of the NHS Confederation – said that CCGs will ‘leave a lasting and very positive legacy’, including the key role of ‘clinical leadership and expertise’ in ICSs.

NHSCC chair and Aylesbury GP partner Dr Graham Jackson told Pulse: ‘Much of the data quoted in the Government’s Impact Assessment Report dates back to 2014 but things have moved on significantly in the intervening years.

‘Clinical commissioners have delivered the clinical case for change and worked hard on public engagement, as well as supporting better understanding of community needs.’

Clinical commissioning provided ‘an important stepping stone’ in the development of both ICSs and primary care networks and led to ‘much-improved collaboration between primary and secondary care on patient pathway design’, he added.

Dr Jackson said: ‘CCGs have shown the real benefits of both clinical and managerial leadership and partnership working, something which will continue within ICSs, as well as highlighting issues around medicines optimisation and good safe clinical practice.’

GP leaders have previously warned that more must be done to prevent ‘tokenistic’ GP representation on ICSs, amid ongoing concerns.

The document also said that the reforms will enable the health secretary to establish new trusts with integrated care contracts that spearhead ‘integration goals’ and ‘align with the delivery architecture of their primary care networks’.

Commissioners could also award single contracts to providers that are responsible for the ‘integrated provision of general practice, wider NHS and potentially local authority services’, it added.

Meanwhile, an accompanying document said that additional funding for the adult social care system in England ‘has the potential to reduce the number of unnecessary GP consultations’ as well as ambulance call-outs and A&E attendances.

In July, the BMA passed a resolution calling for MPs to reject the new bill, arguing it is ‘not the right time’ to be bringing in widespread legal reforms while the NHS deals with the Covid-19 pandemic.

Health minister Jo Churchill has said the bill will ‘do away with unnecessary bureaucracy’ for GPs, in an exclusive op-ed for Pulse.

The Health and Care Bill 2021-22 proposals, which were presented to Parliament in July, will see ICSs placed on a statutory footing so they become responsible for commissioning and bringing together local NHS and local government services, such as those covering social care and mental health.

The BMA has previously warned the proposals would bring a ‘significant change to the working lives of GPs’ and has highlighted concerns about GPs losing out on locally enhanced service contracts if primary care budgets are pooled within ICSs.