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We need to hold CCGs to account



Last week a CCG faced mutiny as GPs from 30 surgeries issued a ‘statement of no confidence’ in their CCG leaders. Their chief clinical officer has flown to Alaska and Seattle to gain inspiration about ‘alternative models of care’ – the current political buzzword for ‘cheaper ways of doing things’. I can understand why the local GPs are fuming. Now NHS England has had to tell off CCGs for offering incentives to reduce suspected cancer referrals.

CCGs are failing to connect with the GPs they are meant to represent

What really gets my goat is that these stories show how CCGs are failing to connect with the GPs they are meant to represent. CCGs were set up to put GPs at the heart of the NHS; to make provision of secondary care more efficient as, after all, GPs knew the tricks and inefficiencies of their local acute trusts. I looked forward to a golden age of CCGs demolishing specialty-focussed biomedical-based secondary care systems and replacing them with patient centred, GP-friendly clinics. Gone are the ENT and ophthalmology clinics. Let’s commission a one stop shop vertigo clinic, with ENT and neurology working together with physiotherapists in the same clinic. That was the dream.

Now it’s gone. Instead, CCGs seem to have brought in more performance management of GPs, they’re seemingly more concerned with our prescribing habits than the gross inefficiency of the secondary care behemoths. Having singularly failed to innovate new solutions to the commissioning of hospital services, they now want to commission primary care too.

The sad truth is that NHS England has become so centralised that GPs at the coalface have voted overwhelmingly for co-commissioning. I’m not sure whether any have voted for this because they believe it is the right system for a modern NHS, but I think most have voted this way simply because GPs and practice managers are now just a number when calling their ‘local’ NHS call centre based 50 miles away. 

I had high hopes for CCGs. I hoped they would radically transform local healthcare systems, breaking down the primary and secondary care divide to develop integrated community services and be more responsive to the needs of the local health economy. Unfortunately, as the GPs in the Vale of York have discovered to their cost, CCGs are no more democratic than their predecessor primary care trusts and have singularly failed to take on the might of the hospital specialists.

My solution? Firstly, the Government needs to reverse the management funding cuts they sneaked in with the Health and Social Care Act and realise that high quality commissioning organisations need high quality management (with the associated costs). CCG leaders need to realise that they need to transform secondary care provision, not just nag GPs about our referral rates. And GPs need to hold their CCGs to account and ensure there’s more engagement than a yearly AGM. Bring on the day when primary care steers the rest of the NHS. 

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative