Exclusive: The majority of GPs feel no more involved in commissioning decisions than they did before the formation of CCGs, according to a Pulse survey which lays bare the professions’ concerns on the eve of the 1 April handover.
Pulse’s snapshot survey of 303 GPs in England reveals the extent of GPs’ disengagement with clinical commissioning just days before the profession assumes responsibility for budgets. Some 55% of respondents said they did not have any more involvement now than they did under PCTs. Just 36% said they did feel more involved.
One in five GPs said they had not signed their CCG constitution, raising questions over the depth of GP engagement at CCGs. Of the 48 GPs who said they had not signed their constitution, most said they had not been asked to, while three said it had not been finalised or had only just been circulated in draft form.
A further 20% did not even know whether or not their practice had signed a constitution.
GPs are also seeing increasing levels of performance management by CCGs, with 83% reporting some sort of pressure from CCGs, despite assurances from the NHS Commissioning Board that this is not the responsibility of CCGs. Some 16% said they had faced a lot of pressure to improve their performance.
The results come after CCG leaders accused the NHS Commissioning Board - now known as NHS England - of a ‘command and control’ mentality when dealing with CCGs.
Dr Chaand Nagpaul, GPC negotiator, said the results called into question the ethos of the Government’s reforms - described by then-health secretary Andrew Lansley as putting decision-making ‘in the hands of professionals’.
He said: ‘The Government had pushed through this agenda at breakneck speed. That did not allow for adequate involvement and organic development for engagement.’
He added that rising levels of performance management by CCG boded ill: ‘This is a recipe for disengagement. If practices feel they are being performance-managed contractually, it will create the potential for adversarial relationships between practices and CCG boards that will replicate the dynamics between practices and PCTs.’
Dr Robert Morley, secretary of Birmingham LMC, said he was worried by the attitude of some CCGs to their constituent practices.
He told Pulse: ‘Of course CCGs have “engaged” with their practices, as every practice has to be a CCG member, and some CCGs I’m sure have done a good job of this. But others have done far less well.’
‘When I look at some of the pronouncements coming from certain CCG leaders across the country, and some of the unacceptable obligations they are trying to put on practices, particularly in their constitutions, which we now know are to be legally binding documents, it makes me shudder.’
Dr James Kingsland, national clinical lead of the NHS Clinical Commissioning Community, and a GP in Wallasey, Merseyside, said he was hearing ‘mixed reports’ from CCGs about their enthusiasm for the changes and their engagement with practices.
He said: ‘Some CCGs are saying clinical leadership is flourishing, practices are engaged, they are facing their public.’
‘[But] others are saying it feels very much like the relationship between the SHA and PCT, where we are facing a reporting system to demonstrate we have done certain things that are required by the area team, which is concerning as we are supposed to be having a completely new system.’
The Department of Health was approached for comment but did not respond ahead of publication.
Pulse Live: 30 April - 1 May, Birmingham
Find out what commissioning means for you and your practice at Pulse Live, our 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.