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


GP commissioning


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.

READERS' COMMENTS [10]

David OHagan 28 September, 2021 9:54 am

The absence of evidence of benefit, is not the absence of benefit.

The evidence will accumulate of the next few years. This will provide a more definitive account of the role of CCGs and clinically based commissioning.

As a GP there has been a significant benefit of increasing the role of primary care in the development of local health economies. GPs have been able to promote care for all patients not simply the few who need 2ry and 3ry care.

This brief intervention into the control of Health by primary care has broadened the understanding of what the health economy is. The ‘Teaching Hospital’ of the 30s became the district hospital, through the first half of the NHS, fundholding, primary care commissioning, and finally CCGs have all tried to change perceptions. The acute hospital remains the biggest cost, drawing the largest influence on the effectiveness of the health economy.

Pragmatically it is vital that lessons about coproduction of services, network and partnership
working are not lost.

Like all systems there have been organisations which have worked better than others. Different CCGs have managed substantially different roles in many different ways. There have been some successful organisations, and some less so effective.

I look forward to seeing how the latest changes integrate the lessons about caring that the best CCGs have taught, and to the evidence being collated and evaluated over time.

MULAYIL KRISHNAN Gopinath 28 September, 2021 10:39 am

We all know that certain folk amongst the GP fraternity found CCG ” work” quite lucrative !!

Kevlar Cardie 28 September, 2021 10:55 am

Won’t Get Fooled Again

The Who

We’ll be fighting in the streets
With our children at our feet
And the morals that they worship will be gone
And the men who spurred us on
Sit in judgement of all wrong
They decide and the shotgun sings the song
I’ll tip my hat to the new constitution
Take a bow for the new revolution
Smile and grin at the change all around
Pick up my guitar and play
Just like yesterday
Then I’ll get on my knees and pray
We don’t get fooled again
The change, it had to come
We knew it all along
We were liberated from the fold, that’s all
And the world looks just the same
And history ain’t changed
‘Cause the banners, they are flown in the next war
I’ll tip my hat to the new constitution
Take a bow for the new revolution
Smile and grin at the change all around
Pick up my guitar and play
Just like yesterday
Then I’ll get on my knees and pray
We don’t get fooled again, no, no
I’ll move myself and my family aside
If we happen to be left half alive
I’ll get all my papers and smile at the sky
Though I know that the hypnotized never lie
Do ya?
Yeah
There’s nothing in the streets
Looks any different to me
And the slogans are replaced, by-the-bye
And the parting on the left
Is now parting on the right
And the beards have all grown longer overnight
I’ll tip my hat to the new constitution
Take a bow for the new revolution
Smile and grin at the change all around
Pick up my guitar and play
Just like yesterday
Then I’ll get on my knees and pray
We don’t get fooled again
Don’t get fooled again, no, no
Yeah
Meet the new boss
Same as the old boss

Subhash Chandra Bhatt 28 September, 2021 1:11 pm

Lovely poem kaviar cardie
Worth publishing

Patrufini Duffy 28 September, 2021 1:36 pm

No clear evidence Government is fit for purpose. Do GPs actually bail the Government and corruption out? Deep question if you wake up.

Kevlar Cardie 28 September, 2021 1:45 pm

@Subhash Chandra Bhatt

Cheers !

I’ll be sure to let Pete, Roger, John and Keith know.

😉

Dr N 28 September, 2021 4:13 pm

No clear evidence that any of the changes made since 1990 have made an ounce of difference. The system was only ever broken by cash starvation not changing logos.

MULAYIL KRISHNAN Gopinath 28 September, 2021 5:24 pm

You definitely won’t be letting Keith and John know Keviar C !!

Thomas Johnson 29 September, 2021 9:06 am

And. Practice based Commissioning dragged the most experienced GPS away from their practices for at least two days per week. It was never going to work when the “Men grey suits” descended on us and imposed their draconian rules shackling our natural instinct to be innovative. A complete waste of money time and effort.

Turn out The Lights 29 September, 2021 9:57 am

No evidence ICS will work apart from their abject failure in Manchester despite being pump primed with extra monies.Prepare for more ‘outperformance ‘ from HMG.