Exclusive: CCG leaders have been lobbying the NHS demanding a toughened-up system for managing the performance of practices, as they were handed responsibility for monitoring GP access.
One GP leader of a CCG angered LMCs across London after calling for a ‘less light-touch' approach on a practice-rating dashboard being introduced across the capital.
The move came as CCG leaders in Manchester began employing mystery shoppers to scrutinise GP access at their practices.
Pulse has learned that NHS London has already added new indicators to its GP Outcome Standards – originally developed in conjunction with Londonwide LMCs - tightening scrutiny on practices and strengthening the role of CCGs.
Dr Michelle Drage, chief executive of Londonwide LMCs, accused CCGs of ‘undermining agreements made by their parent organisations' over moves to toughen the framework.
But the National Association of Primary Care fuelled the row, with chair Dr Charles Alessi describing moves to tighten the framework as ‘very positive'.
The GP Outcome Standards were initially launched last year to hold 6,000 GPs across London and their CCGs to account on 22 performance indicators.
But last week, NHS London revealed it was adding six new indicators following discussions with CCGs, including greater scrutiny at practices of care for alcohol misuse, mental illness and the dying, and a new indicator for the effectiveness of CCGs at monitoring GP access.
A board paper from NHS Central London revealed Islington CCG had asked NHS London to make the process ‘less light touch'.
The paper said CCG member Dr Karen Sennett warned the new tool ‘doesn't encourage higher-rated practices to excel', and that Anne Whateley, deputy director of primary care, contracts and performance, ‘agreed to feed back to NHS London the opinion of one CCG leader that it would be beneficial to have a less light-touch approach'.
NHS North Central London described this as an ‘individual opinion'.
But Dr Charles Alessi, NAPC chair and board member of Kingston CCG, said: ‘The view of the doctors from north London is welcome. If [the framework] remains as it is, perhaps
it doesn't demonstrate quality as much as it could do. It's very positive that people are looking to refine it.'
Dr Drage said: ‘What really worries me are comments that this isn't robust enough. These have been developed collaboratively – it's not about heavy-handed management. It's not CCGs' job to performance-manage the GMS contract. Who the hell do they think they are?'
Dr Chaand Nagpaul, a GPC negotiator and vice chair of Harrow LMC, said: ‘The way [the framework] is unfolding is far beyond the original idea. It is taking on a life of its own.'
Meanwhile, North Manchester CCG has begun mystery shopping its GPs to measure same-day access.
Where CCGs are cracking down on practices
Referrals: Clampdown on high-referring practices
Access: Tight scrutiny of patient satisfaction and opening hours
Prescribing: Close monitoring of practice spend on prescribing