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Local authorities demand role in commissioning primary care



Councils throughout London have written to NHE England chiefs demanding they be given powers to sign off plans that could see CCGs commissioning elements of the GP contract.

In a letter to NHS England chief executive Simon Stevens, the chair of London Councils mayor Jules Pipe has said that approval from health and wellbeing boards – which include representatives from CCGs and local authorities – should be a minimum requirement before any co-commissioning bids are approved.

They also suggest that local authorities and HWBs could play a role in managing conflicts of interest that may arise where GPs on a CCG board may be taking decisions that directly affect them or their colleagues.

NHS England is set to approve bids from CCGs for commissioning elements of primary care, which include plans to take control of directed enhanced services and QOF funding locally.

But the letter from London Councils dated 25 September says that local authorities should have a say over this.

It states: ‘The commissioning of primary care is clearly one important lever for bringing about a transformation of primary care in the capital and we believe local government has a positive role to play in the further development of your plans.

‘For local solutions to be really strong and able to secure widespread local engagement and support, they must be shaped by local authorities as well as CCGs.

It adds: ‘Therefore, as a minimum, we believe a condition for the approval of arrangements for co-commissioning should be the approval of the proposed approach by the relevant health and wellbeing board.

‘The need to avoid conflicts of interests in CCGs taking on co-commissioning responsibilities for primary care is widely recognised, and we believe that the boroughs and/or health and wellbeing boards could play a key role in overcoming this risk.’

The letter states that NHS England will approve, in principle, CCGs’ plans by 12 October, and calls on Mr Stevens to begin talks with local authorities before taking any further steps.

GPC negotiator Dr Beth McCarron-Nash told Pulse the scheme couldn’t be allowed to water down GPs’ voices. She said: ‘Ultimately, CCGs are membership organisations. I’m sure practices also feel that they don’t want to see a watering down of clinical led commissioning.

‘And we feel very strongly that one of the risks of co-commissioning is that it will add so many extra rafts of management and probity issues that come into play. That actually that voice of doctors and clinical commissioners gets watered down further.

‘So obviously CCGs will refer to overview and scrutiny boards and health and wellbeing boards as appropriate, but we need to ensure that the voice of clinical commissioners is strengthened not weakened further.’

At the annual LMCs Conference in York this year, GP leaders rejected the proposals for co-commissioning stating that the issues of conflicts of interest would amount to the ‘ultimate poison chalice’.

But Pulse reported in July that nine out of ten CCGs had expressed interest in taking on a greater co-commissioning role, with responsibility ranging from CCGs being more involved in area team decision making, up to CCGs holding budgets for commissioning parts of primary care.

NHS England is expected to put out further details on managing conflicts of interest in November.