A greater number of lay representatives on CCG boards could pave the way for them to take more control of developing and improving primary care, claimed a top NHS England official yesterday.
Deputy medical director Dr Mike Bewick said it was a ‘waste’ for commissioning groups to have no responsibility in commissioning primary care, laying the ground for a significant shift in responsibility from NHS England to CCGs.
The main barrier was conflict of interest, he added, but this would be solved with stronger lay representation on CCG boards who were able to challenge the decisions of clinical commissioners.
The call comes after clinical commissioning leaders said the time had come for the primary care budget to be deveolved from NHS England to CCGs, but the idea was opposed by the BMA due to concerns over conflict of interest and CCGs performance-managing their own practices.
But Dr Bewick said CCGs were in a better position to know what problems there were with primary care and to support practices that were struggling.
He told delegates at the ‘Federations – the final frontier’ event, organised by Newham CCG and the RCGP, that there was ‘no reason for the CCGs to move from support to actual development’ of primary care.
He said: ‘The CCG is full of provider GPs who are interested in provision, and well as commissioning of the services. It is a waste of their expertise not to utilise that. It is a waste of their expertise for the people who work alongside them. It would seem to me absolutely self evident that those two organisations – CCGs and NHS England, through local area teams – will need to work together and it is the LATs that need to change most to move that forward.’
Dr Bewick referenced his recent interview for Pulse, where he mentioned there would need to be ‘Chinese walls’ to avoid conflicts of interest.
He said: ‘The Pulse interview was very interesting, because I used the term “Chinese walls” to mean there was a division so that people could not be accused of conflict of interest, so there would be a system of good governance.
‘The real key here is that you have good lay representation that would challenge and question decisions.’
This greater role in primary care would, in part, involve a greater degree of performance management, Dr Bewick suggested.
He said: ‘The truth is that no-one [is going to inspect 8,500 practices]. That is another reason why we come back to CCGs. CCGs are membership organisations – they know what happens in their practices. What you want is a sampling methodology – are we delivering it consistently across our patch, are we able to improve it.’
Much of this will include supporting practices who are struggling with the inspection regime. He added: ‘CQC puts an extra burden on you, and for some practices that might be quite difficult and somehow we have to deliver support for those practices. They will be undoubtedly in the places where there is a care deficit. I can guarantee that the 20% to 25% they are talking about as not being fit for purpose will not be in the leafy suburbs. We have to support them.’
Dr Bewick also revealed that health secretary Jeremy Hunt is looking at ways of reducing the bureaucratic burden on clinicians, including the burdens from QOF. He said: ‘The secretary of state is forever asking me to reduce the bureaucratic burden on individual clinicians. I’d like to do that. But there is bureaucracy in what we do. We have to record what we do, to make sure it is safe and has good governance. He thinks QOF is very overpowering for you all.’
Dr Richard Vautrey, deputy chair of the GPC, said: ‘That sounds like we would be recreating PCTs again. CCGs have a role to improve general practice and that means supporting and resourcing general practice, but they commissioning the core elements of GP contracts would be seen by patients and the public as inappropriate because of the conflict of interest, no matter how well it was managed.’