The fundamental problem with these ‘transitional’ agreements is that they seek to tie in practices before there are any regulations that set out what the new contractual arrangements will contain.
For a start, agreements that I have seen deal with risk or risk sharing in terms that could be quite prejudicial to practices. I also have concerns about the extent to which practices should be involved with prescribing costs.
As a starting point, contractors should not be asked to commit to more than they will be required to do by regulation, but all these people are jumping the gun, trying to get people to sign up to all sorts of things.
In other agreements I have seen a number of provisions that cause concern such as fair share budget allocations, budget allocations used to determine voting rights – including allocations to social care – and duties of compliance being placed on all practice members, not just the contractors.
Where there is mention of risk and all sorts of things like that, some of them have really gone far too far. I saw one in the North of England that specifically wanted practices to sign up on behalf of all their staff. That in a sense is complete madness.
You can’t sign up a receptionist to comply with what the CCG does. That’s up to the partners to sort out. The agreements should be approached with some considerable caution. If in doubt, don’t sign until you’ve got clear advice that it is consistent with regulatory requirements.
All the CCGs want to rush to get authorisation, and they seem to think they need to have all this signed up in order to do it. I can’t see that they do. What contractors do is between them and the NHS board.
Andrew Lockhart-Mirams is senior partner at Lockhart’s Solicitors