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NHS England should be slimmed down, says GP commissioning leader

NHS England should have its responsibilities pared down to simply holding the contracts for GPs and consultants, with CCGs taking the ‘central role’ of commissioning primary, secondary and specialised services, a leading commissioner has said.

At a Westminster Health Forum Event in London today, Dr Michael Dixon, chair of the NHS Alliance and a GP in Cullompton, Devon, said if CCGs were going to play a larger role in commissioning primary care and specialist services – as announced last month – then ‘it makes you wonder exactly what the role of NHS England will be’.

NHS England has encouraged CCGs to play a greater role in commissioning primary care, and groups were given until 20 June to submit plans to NHS England explaining how they would use new primary care commissioning powers to sustainably improve care in their areas.

Dr Dixon said welcomed the move, but said CCGs commissioning primary care would lead to a slimmed down NHS England.

He told the forum today: ‘If CCGSs take on the whole responsibility for integrated commissioning, […] it must be them at the centre of the system themselves. It’s not good to have NHS England as the command and control unit, with CCGs as the junior common room of commissioning beneath them.’

‘In fact, if CCGs are taking on all this commissioning, it makes you wonder exactly what the role of NHS England will be.’

Dr Dixon explained that CCGs shouldn’t be holding GP contracts, as this could cause conflicts of interest, and suggested NHS England could keep this role and take on the contracts of secondary care clinicans as well, rather than leaving them ‘chained to the walls of a hospital.’

‘Primary and secondary commissioning services in future, to do that effectively we need to think very carefully about a system that we have at present where our consultant colleagues are chained to the walls of a hospital and also chained to the wishes of their chief executive. So what I’m saying in short is that consultant contracts, like GP contracts, should be held by a third party. Possibly NHS England, possibly academic bodies.’

Dr Dixon told Pulse: ‘I see a flow of resource from NHS England to CCGs, it doesn’t mean you don’t need NHS England but it would be a slimmed down organisation that would be holding the ring, and as you say holding the contracts. And possibly being involved in the discipline, if the contracts weren’t held.’

The concept of primary care commissioning was rejected by GP leaders at the LMC Conference last month, who said that it was ‘the ultimate poisoned chalice’ and would be ‘fatal’ to practice-commissioner relations.

At the same event, NHS England’s director of CCG development said that the Government’s £3.8bn Better Care Fund – which is intended to fund integrated, out-of-hospital care schemes – was hindering CCGs.

The Better Care Fund pools the budgets from health and social care to resource innovative, integrated care schemes. And this will save the NHS money at a time of frozen budgets and relieve pressure on secondary care departments by providing more preventative care in the community.

But a recent report by the King’s Fund health policy think-tank said that the NHS couldn’t sustain the shift of £1.8bn from existing budgets for the Better Care Fund and needed urgent investment to avoid a financial ‘cliff edge’.

NHS England’s director of CCG development Helen Hirst explained CCGs needed to share and develop their schemes for delivering integrated services, outside hospitals, but were going ‘off track’ by focusing on Better Care Fund funding.

She told the forum: ‘The strategic planning process shouldn’t be about fighting over the Better Care Fund.’

I’m not a person who subscribes to the better care fund being a particular enabler, I think it’s taking us off track personally, it has in my area because now we’re focussing on £38 million as opposed to £1.2 billion we spend.’