The GPC and RCGP have called for a wholesale restructure of clinical commissioning groups across the country, with mergers to ensure all groups cover a population of between one and five million patients, in a bid to prevent GPs 'losing the power to commission independently'.
The move marks a dramatic shift in policy for the GPC, which had previously urged CCGs to have a minimum population of 500,000, and is now calling for ‘PCT cluster-sized' federations of CCGs with a shared governance structure.The GPC said the move was necessary to prevent smaller CCGs becoming 'dependant on external support'.
The NHS Operating Framework recently gave SHA clusters until March 2012 to ensure that ‘any outstanding configuration issues' are ‘resolved, meaning GP leaders are effectively urging CCGs to merge within the next three months.
GPC deputy chair Dr Richard Vautrey joined RCGP chair Dr Clare Gerada at Pulse's commissioning roundtable this week in calling for the change, which they argue is required to give CCGs a fighting chance in the new NHS given the recent announcement of a £25 per head management fee for commissioning groups.
Dr Gerada said: ‘One to five million population…is the only way. Then you can start to have sensible people on your commissioning, then you can start to have population base, you can start to be employing the right people.'
When asked whether he agreed with Dr Gerada's summation, Dr Vautrey said: ‘Absolutely. The reality is that CCGs, if they are serious about having any influence at all in the new world, need to coalesce into structures that are equivalent to the old PCT clusters that are there at the moment.'
GPC chair Dr Laurence Buckman today issued a letter to the profession outlining the GPC's plan to fight for a ‘substantial increase' in the management cost, which has led the GPC to alter its advice on how large CCGs should be. Click here to read the full letter.
Dr Buckman writes in the letter: ‘Adequate funding is essential to allow the CCG to be able to function effectively. We do not consider the proposed £25 per head to be sufficient and will be seeking a substantial increase in that sum.'
‘We have previously advised that CCGs should have a minimum population of 500,000, but with strong local structures to ensure they can be truly representative and sensitive to local needs.'
‘However, in the light of the current proposals, we are now recommending that CCGs should be proactive and come together to form a CCG of PCT or even PCT cluster size. It would be big enough to employ its own staff with the necessary skills and expertise to be an effective commissioning body. Staff would work for the smaller sub-groups, (the current CCGs), ensuring they were both protected and empowered within the devolved federation of the larger group.'
‘They could continue to work in the way GPs are telling us they want, but without the need to create unaffordable and duplicate governance structures. This would not be re-creating a PCT, but would be a group led by clinicians who would ensure the smaller sub-groups were really empowered and enabled to take account of local needs.'
Dr Buckman said the GPC would ‘support GPs who want to remain in smaller groups to ensure genuine practice engagement' but added: ‘We believe the way to achieve this is for current CCGs to work together in this federated structure within one statutory body. This would mitigate the risk of smaller CCGs becoming dependent on external support, and almost certainly losing the power to commission independently in an effective way.'