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Primary care commissioning is ‘a mess’ admits NHS England director



NHS England is making a ‘mess’ of commissioning primary care and needs the expertise of CCGs which are much closer to practices, a top NHS manager has admitted.

NHS England medical director Dr Mike Bewick told a group of GPs yesterday that local area teams were too ‘far away’ from practices and that co-commissioning with CCGs was the way forward.

Speaking at one of NHS England’s ‘Call to Action’ events, hosted yesterday by Newham CCG and the London area team, Dr Bewick said that more sustainable models of primary care were needed.

He said: ‘The last point I want to make […] is about commissioning of primary care. It is a mess, to be prompt with you. It was a mess beforehand when there were 152 PCTs, and it is a mess now with 27 [area teams] – mainly because they are so far away from you, the area teams, so it is impossible for them. We have become yet again a contracting organisation and not a commissioning organisation.’

He added: ‘I think we can change that by utilising the expertise that we have in CCGs, who know the practices, their membership organisations. And with the health and wellbeing boards, who know your populations – or should know your populations, I should say – and looking for models that actually are sustainable across the system.’

‘So I am trying to argue for a level of co-commissioning across primary care, that will probably be for co-commissioning out-of-hospital care and working with other partners.’

The comments come after a survey found over 40% of CCG leads believe NHS England does not share their vision for primary care.

Speaking to Pulse after the meeting, Dr Bewick said that he had been trying to make the point – made by himself and other leaders at NHS England – that CCGs should commission primary care jointly with area teams.

He said: ‘The reason I said it is a mess is because I think people don’t really know where we are going to be commissioning this transformed primary care from. To try and get some semblance of that we have got to connect the commissioning across the systems, from direct commissioners along with CCGs. Because CCGs, as you know, has that responsibility, and therefore the budgets, to improve quality. So that we use some of that money more innovatively than we do today.’

Dr Bewick’s comments are the strongest yet suggesting that NHS England will act on a call from NHS Alliance chair Dr Mike Dixon for CCGs to be more involved in commissioning primary care.

But he will face opposition from the BMA, who have said that it would result in conflicts of interest and mean GPs in CCGs would have to performance-manage their own contracts.

NHS England chair Professor Malcolm Grant said in October that the obstacle of conflicts could be overcome, and Dr Bewick in September, when he said it could be solved by having more lay people on CCG boards.