CCGs should have power to ‘decommission’ GPs and practices that aren’t up to standard, commissioning leaders have said.
NHS Clinical Commissioners said that despite CCG efforts, ‘poor practice persists’ and currently CCGs are left ‘waiting for the chief inspector of GPs to take action’.
In a new report, they call for better identification of failing GPs and practices and for NHS to support action with ‘contracting levers’.
The ‘Commissioning primary care: transforming healthcare in the community’ report read: ‘Poor practice persists, however, and the contractual rules make it hard for commissioners to take robust and timely action against underperforming GPs. Waiting for the chief inspector of general practice to take action is not enough.’
‘The rules need to be changed to enable commissioners to decommission GPs who are not up to standard; CCGs need to be robust in identifying individuals and practices who are failing, with NHS England supporting that action with the appropriate contracting levers.’
The report also challenged the current framework for primary care commissioning and is particularly critical of Area Teams, labelling them ‘distant and transactional.’
The report stated: ‘In many areas CCGs have been waiting for area teams ro come up with comprehensive primary care strategies that have, largely, either not been forthcoming or been drawn up with little CCG involvement.’
‘Local area teams have limited capacity to expand and reform primary care because they are being forced to spend most of their time on contracting process [sic].’
To remedy the situation, NHSCC called for NHS England to grant ‘more autonomy’ to CCGs.
The report read: ‘Greater autonomy in deciding in their local approach to primary care commissioning, rather than adhering to a single operating framework.’
Meanwhile, NHS CCG also argued that practices need to accept greater transparency and accountability measures – such as publishing GP pay – as the ‘price’ for transferring more resources from secondary care into primary care services.
Dr Steve Kell, co-chair of NHSCC, said: ‘The development of primary care is most effective when there is close collaboration between CCGs and local NHS England area teams.’
‘There are a range of well tested and effective mechanisms that can easily be put in place to ensure CCG decision making processes remain open. Taking these steps would free up all parties, allowing them to remain accountable and still push local service improvements forward.’
NHS CC’s report claimed to set out key messages from a roundtable event with CCG leaders and representatives from the NHS England, BMA and RCGP in November, but is published solely by NHS CC.
It is not the first time GP leaders have called for more stringent controls on GP practices, and CCGs began monitoring access to GP services already in 2012, when still in shadow form.