This site is intended for health professionals only

One in three senior GP commissioners disillusioned with commissioning powers

Exclusive: One in three GPs who is heading up their CCG have less power and influence than they expected to have when they first took up the role, a Pulse investigation reveals.

Pulse carried out confidential interviews with 43 GP chairs of CCGs, to gauge their views on the commissioning process with just four weeks to go until the handover from PCTs. Speaking on condition of anonymity, a substantial minority said they had become disillusioned with their influence on the commissioning process even before they formally begin their role in April.

In total 13 of the 43 GPs interviewed said they did not have as much power as a commissioner as they had expected to have when first agreeing to take on the role. A further five CCG chairs said their expectations had been met, but only because they were low to begin with. Two said they did not know, while 23 said they did have the same power they expected.

Many of those interviewed said they were particularly disillusioned by the amount of power which has been transferred to the NHS Commissioning Board.

One female CCG chair said: ‘The Commissioning Board is commissioning primary care and doing what they want.’

Another in the south of England said: ‘It was initially billed as GP commissioning, but the NHS Commissioning Board now controls a significant proportion of the commissioning budget.’ The £25 per head budget was ‘not enough’ and CCGs are over-reliant on commissioning support units, the chair added.

Others said that CCGs were struggling to deal with other bodies such as local authorities assuming new powers. The chair of one urban CCG said ‘commissioning NHS services has been disintegrated’.

Another GP in the south of England said CCGs had found they needed to ‘work with providers to achieve changes’, while the leader of one CCG which has already achieved authorisation said: ‘More services than I expected have been moved to the local authority with public health.’

Dr Jonathan Shapiro, a former GP in Birmingham who is now a CCG development consultant, said: ‘Over the past 20-30 years, there has been a constant raising of expectations that GPs are going to be more in control and have more influence. Every time expectation has been raised, it has never quite been met.’

‘My concern is that when you raise an expectation but don’t meet it, there is a risk people will just stop playing. Because GPs work the way they do, they could stop playing and that would cause an enormous impact at a strategic level.’

Dr Michael Dixon, interim president of NHS Clinical Commissioners, said there were many reasons why some CCG leaders had become disillusioned, with the recent row over competition rules symptomatic of complexities stymying real change.

He said: ‘There are complexities of commissioning that are not necessary. We have been talking this week about the need to cover your back to make sure you have not been anti-competitive, for example.’

‘Another issue might be some bodies are so short of money, it’s quite difficult to frontload new services when you are closing down old ones. So the room for manoeuvre is much less than they had hoped in terms of wanting to reconfigure.’

Read Dr Michael Dixon’s full comments here

But Dr James Kingsland, national clinical lead of the NHS Clinical Commissioning Community, and a GP in Wallasey, Merseyside, said: ‘The question I would ask those CCGs is who has got the power? They are the most powerful clinicians in the system. If they have not got the power, who has?’

‘On the 1 April, we only have two statutory bodies – the Commissioning Board, which is not there to performance-manage CCGs, and the CCGs themselves, which are supposed to be independent.’

‘They should look at what the law allows them to do. The power has been devolved to clinical leaders and it is as much within their remit to capture the ground if they feel that they are not having the say or the independence they expected.’

Pulse reported this year that CCG leaders in London were feeling disillusioned with having to deal with ‘mega trusts’, which were diluting their commissioning powers. Lewisham CCG clinical board members have also threatened to resign over health secretary Jeremy Hunt’s decision to downgrade Lewisham A&E.

The NHS Commissioning Board was unavailable for comment at the time of publication.


Pulse Live: 30 April - 1 May, Birmingham

Dr David Carson, director of the Primary Care Foundation, will be speaking about how practices and CCGs can tackle the process of reducing emergency admissions at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.