In recent weeks there has been intense speculation about CCG constitutions. As always with contentious issues, the real facts have often been lost in the fog of debate, leaving many GPs unsure as to how this vital issue will affect them in their daily working lives.
CCGs are statutory bodies and as such GP practices are required by law to be a member of them. But what does this mean in reality for your average GP?
To give you an example, my practice currently has a GMS contract that is held by the PCT on behalf of the NHS. From April 2013, this contract will be managed by the local area team (LAT) of the NHS Commissioning Board for England.
Issues relating to essential and additional services, the QOF and nationally negotiated enhanced services will all be managed by the LAT. But my CCG will also be able to commission local contracts (currently known as local enhanced services) from my practice.
The purpose of the constitution is to provide a clear document that sets out how a CCG is established and maintained, both in terms of elections and structure.
Getting the constitution right is therefore vital. For it to operate properly and fairly, practices must be allowed to get involved in shaping their local constitution in order that it is democratic – and thereby reflective of the views of local GPs – and that its structures are fair, just and appropriate.
In many areas, the embryonic CCGs have done their best to get this engagement right.
But unfortunately this has not been the case everywhere. As CCGs undergo the authorisation process, there have been a number of worrying reports about pressure being applied on practices to sign their constitutions. LMCs have told the BMA that some GPs are being presented with constitutions a day before they are expected to sign them.
Others have highlighted worrying gaps in electoral logic, for example restricting the franchise to those who work a certain number of sessions – thereby excluding swathes of salaried GPs from the ballot box.
There are also reports of pressure being applied through emails and phone calls to get these constitutions signed, whatever their shortcomings.
This is simply not acceptable. CCGs have a responsibility to engage with their local practices to get a constitution right – and they should not be seeking to rush ahead with a ragged document full of holes.
Read the small print
I am acutely aware that for GPs, struggling as we all are with a high workload and financial pressures, it can seem like a huge task to try and tackle this complex situation while juggling the demands of the day job.
In order to help with this, the BMA has produced detailed guidance outlining how practices should approach the formation of their CCG constitution.
It provides a clear steer, no matter what stage of the constitution’s formation you are at – whether at the start, halfway through or even at the supposed ‘end’ of the process.
I would advise all GPs to look at this document so they understand where they stand. This includes realising that they have the right to raise any issues they have with their proposed constitution directly with their CCGs (as well as LMCs), and that a constitution can be amended even after it has been signed, because they do not come into force until 1 April 2013. The guidance also provides an important checklist of what should be in a constitution, from the proper make-up of the franchise through to the vital point that a CCG should not be allowed to impose any sanctions against practices.
During the writing of this article, I was struck by how far we have unfortunately strayed from the promise of clinical commissioning which, at its core, still could offer benefits to general practice and patients.
It is essential that we move on and start to focus on what CCGs can deliver – and help them to do that, rather than waste time and energy on organisational development.
Encouragingly, some CCGs seem to have approached the constitution process in the right way – that is, in partnership with LMCs and practices.
But GPs need to be vigilant to make sure that their constitution is fit for purpose. They must not leave it to CCGs to define their future.
Dr Nigel Watson is chair of the GPC’s commissioning and service development subcommittee and a GP in the New Forest, Hampshire