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Senates ‘to be modified’ to free up GP commissioners

Government plans to introduce clinical senates to oversee GPs' commissioning decisions are set to be ‘modified considerably' to address concerns that they will stifle the freedom of GPs to bring about change, according to one of the Department of Health's pathfinder leads.

Ministers outlined proposals to create the new senates to run the rule over decisions taken by clinical commissioning groups (CCGs) as part of changes made following its three-month listening exercise.

But the move has led to disquiet among GP commissioners, amid fears that senates will create a power struggle over commissioning and ‘neuter' new CCGs.

Dr Paul Zollinger-Read, director of commissioning development for NHS East of England and a Government lead on its pathfinder learning network, said CCGs had raised concerns about the role senates would play, and that he expected changes to how they were set up. Dr Zollinger-Read is responsible for key areas of commissioning including the development of authorisation for consortia.

It comes after Pulse's sister paper Practical Commissioning revealed last week that the NHS Alliance had received assurances from ministers that they would limit the role of senates in GP commissioning amid fears that GPs were being sidelined.

Dr Zollinger-Read said: ‘The issue that has been bugging CCGs is whether they are they going to have to play second fiddle to senates. I suspect that has been listened to and I would be very surprised if it isn't modified considerably. I think that's definitely going to happen.'

‘Quite rightly concerns have been raised. Senates came in at the last minute, and CCGs are struggling. I had a teleconference with 10 of them yesterday and that's an area that they are still struggling to understand.'

Dr James Kingsland, the DH's national commissioning lead and a GP in Wallasey, Merseyside, said it was important to establish a ‘clear narrative' over the role clinical senates would play, but said he didn't expect them to be enshrined in law. ‘I'd be surprised if it was in legislation. But I fully expect them to be described in direction and policy,' he said.

A ministerial source told Pulse that the Government was anxious to ensure that CCGs had full autonomy to pursue commissioning plans, and that those that wanted to press ahead were free to do so now.

The source said a key focus within the DH over the next six months was on building up capacity within CCGs, with the forthcoming authorisation framework clarifying exactly what's expected of them.  

The NHS Alliance has called for the authorisation process to be a dialogue rather than an ‘arms' length assessment', with other bodies such as the NHS Commissioning Board and PCT clusters working with and supporting CCGs who are not ready, rather than taking over their commissioning responsibilities.

Dr Michael Dixon, chair of the NHS Alliance, said it was imperative that CCGs were permitted autonomy and not shunted to the bottom of the commissioning hierarchy following changes to the Health Bill.

Dr Dixon said: ‘CCGs will play a crucial role in the new NHS and there needs to be a lot more dialogue between them and the centre regarding their authorisation and implementation.'

‘At the moment, it seems that they will be put in a position where other bodies will be telling them what to do, which goes against the Government's commitment to put CCGs at the heart of modernisation plans.'