Define what the practice wants from the CCG and refer it back to them
CCGs are membership organisations. From a practice perspective, you should see this as your CCG, not a separate body. This is a fundamental change from PCTs, and relationships have become more important in the new system.
CCGs are still learning what to do in many ways so this is as an opportunity to define what the practice wants from the CCG, understand what the CCG needs from the practice and where there are gaps in the current arrangement change them. It is particularly important for the practice manager to be involved in this, as the practice now has different contracts with NHS England, local authorities and the CCG and the role of each needs to be clear. The service the practice is keen to develop may need NHS England or the local authority input rather than the CCG.
Dealing with individuals who are poor listeners and have a brusque manner is always difficult. It can be especially difficult if the person is a GP colleague from another practice. This should be referred back to the CCG. CCGs have a responsibility for their own organisational development, and developing their own staff.
An initial informal approach, to the chief officer or chair, could raise concerns that that the current relationships aren’t effective and are preventing the CCG and the practice get the most from each other. Hopefully the CCG team will be able to resolve the issue informally through personal development or changing the practice liaison member. If not then the practice should consider formally raising a dispute according to the CCG constitution.
Membership organisations need members to work. The CCG should be as concerned as the practice if there is a problem.
Dr Steve Kell is chair of Bassetlaw CCG, co-chair of NHS Clinical Commissioners leadership group and a GP in Worksop
Establish the key issues and involve another CCG liaison representative
Communication is a key part of CCG working and a key determinant in GP engagement. This is very much related to your membership agreement and there should be an escalation process.
Regardless, at first, I would try to establish what the key issues are, and try to address these with the directly with the liaison saying you are not happy and ask for some action. If that is not satisfactory, I would suggest involving another liaison - via email or another meeting - who could then raise this with the CCG.
Depending on your local process, the matter could also be brought up at your open forum with the CCG and/or brought to the CCG’s attention through the practice risk log that feeds into the CCG´s risks log.
Failing this, you could raise this directly with the chair or the chief operating officer for the CCG. All CCGs will be keen to resolve issues like this and try to keep an open and transparent dialogue. The CCG will be keen to look into this further as there maybe other practices with similar issues which will need addressing.
Dr Jagan John is a clinical director of Barking and Dagenham CCG and a GP at King Edwards Medical Centre in Barking
React as a locality, rather than as a lone voice
This scenario goes to the heart of the practice’s relationship with the CCG, and its relationships with other practices.
Some CCGs understand that getting member practices on side is core business. Without that engagement, CCGs will lack a clinical mandate to change local services and will be unable to tap into the expertise of clinicians and practice managers to make well-informed commissioning plans.
But engagement is a two-way street and practices shouldn’t just lie back and wait for the CCG to woo them.
In this example, the question arises about what the practice had done to make the business case for its idea. Did it do a good job communicating the idea? Did it seek the support of other practices in the area by involving them in the discussion? Did it do any other testing of the idea – a survey of patients perhaps – to provide evidence that would make it hard to ignore.
Acting as a locality, rather than as a lone voice, will always give ideas more traction. The poor communicator could have been invited to hear about the plan at a meeting to which the CCG accountable officer and clinical lead could also have been invited.
The message is: don’t wait to be invited to the party. If you take ownership of your part in the development of the local health system, you won’t need to be on every committee to make your voice heard.
Rebecca Thornley is associate director of Primary Care Commissioning
