Clinical commissioning is an ideal that few people would argue against. The merit of moving the control of services closer to patients and local clinicians is obvious. It could, if done properly, lead to a more responsive NHS, where services more closely match the needs of the local community and where clinicians can use their expertise to craft the best care for their patients.
Clinical commissioning also offers skilled salaried and locum GPs a real chance to get directly involved in decision-making and the delivery of NHS services, and for CCGs to use the best skills available to them to make this work to benefit of our patients.
To realise this potential, the BMA has argued that the election process for CCG boards should be ‘one GP, one vote’. Given the significance and power CCG boards will hold, it is imperative all doctors be given an equal opportunity to influence who is elected and takes part. LMCs, as local representative bodies for GPs, must also be involved in this process. There must also be a proper period of engagement.
As a working GP, I am forever buried in paperwork and bombarded with communications from many organisations. CCGs must therefore make sure they are engaging with and catching the attention of all doctors on the ground.
There needs to be a genuine effort on the part of both CCGs and PCTs to maintain proper contact details and intranet access for all GPs, and enough time must be set aside to tell doctors what is going on, how they can respond and take part.
Unfortunately, evidence is emerging that some are not adhering to these practical steps. LMCs are reporting that some practices are being pressurised into signing constitutions at short notice, without adequate consultation periods and with marginal LMC input. In other areas, LMCs have been excluded from consultation on the representation process.
Lack of engagement
One LMC has reported to the BMA that GPs have been presented with a clause in their constitution that could exclude salaried GPs and will certainly exclude locum GPs, as it demands the franchise is only open to those carrying out at least four sessions a week in a practice.
Other LMCs, referring to the rush to authorisation, are suggesting that engaging GPs is becoming difficult because there is not enough time to get communications out about the CCGs and how they will operate.
The mad rush to get CCGs authorised, the lack of commitment displayed by some CCGs in engaging with all GPs and arbitrary restrictions within the constitutions that exclude locum GP colleagues in particular are all unacceptable. Although they impact on other clinicians, salaried and locum GPs are most significantly affected, and it is unsurprising that reports suggest participation among these GPs is not where it should be.
There is still time to correct this process, although it is fast running out. CCGs must make a real effort to draw in GPs from across the profession and they must go through their constitutions to eliminate passages that will block the engagement of salaried and locum GPs at all levels.
Engagement means sessional GPs being able to vote in and stand for election to the board, having the chance to become involved in organisational aspects of healthcare delivery, and getting the same access to leadership development and funding support as GP partners. Moving ahead without the engagement of this core part of the workforce will leave CCGs sorely lacking the range of skills and expertise required to develop services for patients.
GPs must push their CCGs hard through direct lobbying, especially by working with their LMCs, to make their constitutions acceptable. If they do not get the results they are satisfied with, they should contact the BMA at info.commissioning@bma.org.uk.
We must make an effort to get the CCG process right. It will not be easy and will depend on those behind the process listening to feedback. But it is our job to make sure the voices of concern and reason become deafening.
Dr Vicky Weeks is chair of the GPC’s sessional GP subcommittee and a salaried GP in Southall, west London
