Two practices have been forced to join their CCG by the NHS Commissioning Board against their wishes, in a move GP leaders say makes a mockery of Government claims the new bodies reflect implicit GP support for their reforms.
The NHS Commissioning Board used its legal powers to force two practices in Essex to to become members of NHS Basildon and Brentwood CCG and NHS Thurrock CCG – the two worst performing CCGs in the country – against their wishes.
The development comes as the board announces all 211 CCGs in England have now been authorised to take on responsibility for commissioning local NHS services from April.
The board also revealed that only 43 CCGs have been fully authorised, and a further 153 have been authorised with minor conditions and 15 were given legal directions for an intensive level of support from the board.
Those 15 CCGs will have troubleshooters appointed by the board to help them with their day-to-day functions and include NHS Basildon and Brentwood CCG and NHS Thurrock CCG – the two organisations who have had GP practices allocated to them against their will.
The board has also refused to ratify the accountable officers in NHS Basildon and Brentwood CCG and NHS Waltham Forest CCG, and has removed specific functions from these CCGs, and NHS Thurrock CCG, as part of its final wave of authorisation announced today.
GP leaders have warned that the forced allocation of practices onto CCGs demonstrates that GPs have no choice but to sign up to the Government’s reforms and reflect a lack of engagement with member practices in some areas.
Dr Chand Nagpaul, a GPC negotiator, said the move was the final admission that CCGs cannot be called ‘membership organisations’.
He said: ‘The idea that CCGs are membership organisations has always been a misnomer because all membership organisations give you a choice over whether to be a member or not.
‘These are forced membership organisation and the Government has made it clear that those GPs that don’t agree to be in a CCG will be forced to be in the CCG. This is in keeping with the Government’s policy.’
Dr Brian Balmer, the chair of Essex LMC, said that the problems in Essex reflected ‘historical splits’ between practices within the CCG areas that had not been improved with the NHS reforms.
He said: ‘I think commitment from GPs in general is not that strong and in some areas the GP leadership has struggled to bring them together in any sort of coherent way.
‘In some areas there is some reasonable sign up. But I am not convinced GPs are truly signed up to the agenda. It is compulsory, they have got to be in CCGs. The Government will make a big thing of all practices being in CCGs, but they have no choice.’
Dr Anil Chopra, local GP and chair of NHS Basildon and Brentwood CCG said: ‘We fully expected to receive some authorisation conditions during this stage of our development and acknowledge that there are some challenges for the CCG, its providers and the whole health economy.
‘We are committing to working in a consistent and methodical way to remove the conditions placed upon us and although some of this may take time we have already made considerable progress in establishing the new organisation and tackling challenges across the system.’
A spokesperson for the NHS Commissioning Board said although practices have a ‘legal requirement’ to be members of CCGs, they hoped GPs would fully engage with them to help design local services on behalf of their patients.
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She said: ‘The CCGs concerned have been working hard over the last few months to achieve sign-up and the relevant regional teams have been involved with this. As membership organisations, CCGs’ strategy and direction are set through consultation and engagement with their member practices.
‘We would urge all GP practices to fully engage with their CCGs in order to help design local services on behalf of their patients and develop their CCGs into mature organisations which are fully responsive to their local communities’ unique needs.’
Dr Anwar Khan, interim chair of NHS Waltham Forest CCG, said: ‘The board understands the significant challenges ahead in addressing the conditions and directions. We are committed to working with NHS CB and other partners to address these.’
List of CCGs with legal directions
- NHS Basildon & Brentwood CCG
- NHS Croydon CCG
- NHS Eastbourne, Hailsham and Seaford CCG
- NHS East Surrey CCG
- NHS Enfield CCG
- NHS Herefordshire CCG
- NHS Herts Valley CCG
- NHS High Weald Lewes Havens CCG
- NHS Medway CCG
- NHS Nene CCG
- NHS Newham CCG
- NHS Scarborough and Ryedale CCG
- NHS Thurrock CCG
- NHS Vale of York CCG
- NHS Waltham Forest CCG