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Proposals to abolish CCGs of ‘significant concern’ for GPs, BMA says


BMA survey


The BMA has said that NHS England proposals to abolish CCGs are of ‘significant concern’ for GPs.

The plans could cause ‘significant changes to their working lives’ if they go ahead, it added.

In November, NHS England revealed that CCGs could be replaced as commissioners by ICSs as part of new proposals for integration. 

The proposals included two options – one CCG only per ICS with CCGs to ‘delegate’ population health roles to ‘providers’, or the ‘repurposing’ of CCGs with their statutory functions transferred to the ICS.

In its formal response to a consultation on the plans, which closed last week, the BMA said it had ‘profound reservations’ about some of the proposed changes, which included a ‘serious lack of clarity regarding the practical implications of transferring CCG powers to ICSs’.

It said: ‘This lack of clarity means that the potential changes to CCGs are a source of significant concern for GPs and GP partners, who may face significant changes to their working lives as a consequence, and NHS England must provide complete clarity on where and to which bodies CCG powers may be transferred.’

NHS England had also said it will create a ‘single pot’ of funding, bringing together CCG commissioning and primary care budgets along with other funding allocated to systems.

But the BMA warned that core general practice funding and local funding arrangements ‘must be protected’ to ensure both the partnership model and the independent contractor status of GPs remain financially ‘secure’.

It added that there is a ‘troubling’ absence of references to GPs in the plans and they ‘fail to provide a clear, strong voice’ for clinicians.

‘Urgent clarity’ is needed to ensure power will not be ‘concentrated’ at ICS level and away from frontline clinicians, as well as a ‘formalised role’ for LMCs in any new structures, the BMA said.

The consultation response also raised concerns around how PCNs will be ‘supported’ to fulfil new functions proposed as part of future ICS developments and suggested the repurposing of some CCG management resources to PCNs.

And the BMA called for a longer consultation period to take place in order to restore ‘credibility’ to the process and plans.

It said: ‘We believe the timescales given to respond meaningfully to these proposals, which have far-reaching consequences, have been unrealistic and inadequate. 

‘Coming as it does amid the ongoing global pandemic and the immense pressures the NHS is facing this winter, our members have understandably been focused on the provision of vital care and the implementation of the vaccination programme.’

It added: ‘This has meant that many have been unable to give these plans the consideration and scrutiny they require which, in our view, risks undermining confidence in this process and the proposals themselves.

‘We believe it is therefore imperative that this engagement exercise should be followed by further consultation.’

The NHS long-term plan said ICSs will cover the country by 2021 – with ‘typically’ one CCG per ICS area – meaning there will be fewer commissioners who will become responsible for larger geographical areas.

But LMCs have previously warned that a reduction in the number of CCGs in England so they match the number of ICSs will ‘reduce the voice’ of practices.

READERS' COMMENTS [15]

David Mummery 15 January, 2021 10:17 am

‘Integrated Care’ is a total con.
Basically it’s the relegation of Primary Care to the second order and making ‘General Practice’ and GPs no longer one if the professions

David OHagan 15 January, 2021 11:00 am

The proposals are intended to diminish the role of GPs in decision making in the NHS.
The view of NHSE, and the hospital trusts is that GPs should never have been given the role, this is their opportunity to reverse what they see as an error.

Their mistake is to misunderstand what the NHS is. The figure of 85% of activity being in primary care is disputed, but the fundamental point about primary care is that it is where patients meet the NHS. The actions of GPs are going to determine the spending, the referal patterns and the differing demands on the rest of the system. They are the patient’s advocates.

Trying to give more power back to hospital trusts, and to bring them back into the centralised bloc of NHSE control is not a bad thing. The freedoms thay have had have mainly resulted in pockets of good performance, and other pockets.

The new kids are the community trusts, they are a significant set of players in the current NHS, and feel they will be at the table with the Hospitals, hence their cautious support for reforms. We will see if that is the view of the foundation trusts and their ‘professional associations’.

ICSs are not about care, they are about integrating the ‘market’ reforms of the 80s back into a centralised ‘stalinist’ rationally planned monolith. Some of the lessons about such structures have been learned, but many forgotten. It is certainly integrated!

Where the working of the system has been considered, where it is planned around services and patient flows, there is an opportunity to build in some improvements with this iteration of the endless wheel of political tinkering. Where it will fail is where local working is ignored and the monolith placed randomly by whim of the Satrap.

It is also interesting how much is being done following a few words from the top table, with no legislation, no more than whispers from government; a government with quitte a lot else to do , and little understanding of what it needs to do or how. Anything could happen, and we all need to be ready to unravel the ‘hinted at’ changes just as soon as the wind starts blowing in a different direction.

Patrufini Duffy 15 January, 2021 2:08 pm

Good points David. This was a 10 year plan in process. The CQC shut down small practices and single handers obliterated. “Working at scale” they branded it. The IT is now remotely monitoring every one of you, appointment slots, free slots, scripts, drug monitoring, referrals, 2ww uptake, screening, immunisations – you are have already been “integrated” via the back door. Your data sharing agreements and SnowMed coding paved more ways. This cannot be new news. Once they had your appointment book (AE, 111, patients via access) the alarm bells should’ve rung. Then they roped you and huddled you into PCNs via a sneaky DES in the midst of a global pandemic. And 98% of you signed up sheepishly. THAT was the cheque-mate move. You are going to be the new social care. Get used to it. You sadly cannot stand in the way of GovUK ministers and the hundreds creating models on how to silence your voice and there are very big players across the Atlantic and private providers who have infiltrated and influenced NHSE all ready now to “disintegrate” specifically you. Because you are their ultimate obstacle. I’d just like to find the real dossier of the 10 year plan (because they know it, and while you keep vaccinating, appraising, striving for indoctrinated continuity when “leaders” couldn’t care less, running from inspectors and threatened by the GMC your good friends Hancock, Kanani and Waller can organise, and they aren’t going to tell you what they’re really going to do to you). Get a houseplant – it’ll bring you more peace.

David jenkins 15 January, 2021 3:11 pm

get out. come to locumland. luckily i operate in wales, where different clowns run the system. as a locum, you may have less certainty over your long term work, but you certainly have more control over your hours, conditions, rates of pay, holidays, time off etc etc etc.

if any surgery mucks you about, or takes the piss, just decline extra work from them. in 14 years i haven’t had to do so – all the surgeries in which i work are great.

you pull your weight and look after them, and they will do the same for you, and you don’t have to have any contact with ccg’s, pct’s or whatever their latest sexy title is !

Nick FOREMAN 15 January, 2021 6:22 pm

Round and round it goes. Centalisation /Localism, FPCs, FHSA, PCGs,. PCTS, Regional Health Authorities, Area Health Authorities, District Health Authorities,
CCGs, A huge variety of trusts etc etc. Nothing lasts longer than seven years.
The only thing that stays the same are the patients in front of us and the struggle, as it always has been, is to maintain the continuity of that relationship.

Nick FOREMAN 15 January, 2021 6:24 pm

And fundholding of course!

terry sullivan 15 January, 2021 9:35 pm

privatize the nhs–its the only way

John Glasspool 16 January, 2021 1:47 pm

20 years ago + there was talk of a “Primary Care-led NHS”. We had PCGs, then PCTs, then CCGs. A pattern emerged. GPs NEVER really allowed to make any decisions. It was “feed the money to the hospital at all costs”.
Mind you, it did give nice committee-based sinecure-type jobs to some of the doctors who weren’t up to dealing with patients 4-5 days per week. I have nothing but contempt for them.
20 years of waste of time in the NHS.

David OHagan 16 January, 2021 4:50 pm

As a GP who ‘isn’t up to dealing with patients 5 days a week’ I am certain that the job of being a doctor seeing patients will continue.
To presume that working privately or as a locum in some way insulates a person from the effects of a deteriorating system is optimistic.
As general practice continues to spiral around the plughole of history there is a point at which it is changed fundamentally.

Vertical integration with ‘new improved primary care’ simply as the front end to hospitals. A system manned by physician assistants, and social prescribers, with a nurse or too to supervise, and a named medical director is one with poor care, and few locums. Primary care pre NHS was a place of medical poverty, and unemployment. The Citadel is a suitably optimistic positivist view of ‘the good old days’.

The public does not value the medicalisation of life enough to want to pay for it, ahead of the necessities such as SKY TV, and that’s the middle classes.

CCGs were the the first organisations were there was a legal brake built in slowing the drain of cash in to the gravitational well of the general hospital. That it wasn’t allowed to work is not too surprising, It is also unsurprising that there is now retrenchement.

What we mustn’t do is to allow General Practice to be thrown out with the bathwater by failing to appreciate the risks. We mustn’t stare down the drain and think that’s the shiny sea down there.

Kevlar Cardie 18 January, 2021 3:10 pm

Great news for brass plaque engravers.

Honest from Yorkshire 18 January, 2021 6:46 pm

I managed 23yrs of nine session all clinical work and packed in at 50yrs old. Please remember that we are generally bright, hardworking, and diligent; if you apply those qualities in another field you will reap the rewards. Pension taken early plus a small internet business taking 2-3hrs each day produces income in excess of mine as a f/t partner. Good luck to those who remain but the NHS is doomed, you will never meet patient, media and political expectations.

James Boorer 19 January, 2021 2:16 pm

Before bringing on the doom and gloom maybe this is an opportunity for primary care. We are what keeps the overall NHS safe, effective and affordable. GPs have a key role in managing risk and population health. If I was an insurer in a private medical system of someone trying to balance the books in an ICS I would be absolutely putting primary care at the centre of any plan. GPs are hugely important and I sometimes wonder if we forget this ourselves. I’m fortunate to work in Plymouth with a great hospital trust where they recognise the importance and value of GPs in keeping overall costs down through good preventative medicine. Lets state our case, get involved with ICS programs and make a difference : )

David Turner 20 January, 2021 2:23 pm

All of the above is true, but partly, we bring this about ourselves by not recognising our true worth.
None of the pen -pushers coming up with this nonsense would last a day in out shoes even if they were qualified.
As a profession we need to stand our ground and make it clear what we are and are not willing to do and stop being dictated to by back office nobodies.
And don’t rely on the BMA to stand up for us, too many of them are happy to do the government’s dirty work with the promise of a gong at the end!

David OHagan 21 January, 2021 3:07 pm

The idea of engaging with ICS schemes would be great if they had any mechanism for engaging with GPs. Those so far which have used GPs are having to reapply for recognition. The proposed statute writes GPs out.
Primary care is absolutely essential to reducing costs and improving outcomes.
A progressive model would make primary care central to the ICS approach. What is proposed has foundation trusts as the core, with NHSE as support. Primary care is mentioned in the small print somewhere near the end.

These self defeating proposals will be damaging to the health care system, they will be damaging to us as individual professionals, and they will be damaging to the health of the populations they claim to serve.