Promoting the interests, aspirations and welfare of general practitioners in North and South Essex

Will anything be different when GPs and practices are in Clinical Commissioning Groups (CCGs)?

The NHS reforms are under way and are starting to take shape.  Fledgling commissioning groups are currently engaging with PCT clusters and gradually having more influence over commissioning.  They are starting to be assessed by the SHA and this will continue until the Authorisation process begins around October 2012.  This may seem to be some distance into the future but, if the Government agenda is to be followed, all of us will be affected very soon.  There are many details as yet unknown, and the Health and Social Care Bill has not yet completed its passage through Parliament, but it is clear that CCGs will have an increasingly important role in primary care and across the wider NHS.

CCGs might become stifled by bureaucracy and merely have token GPs at their centre, but this is not the stated option of the Government and such a scenario would fail.  It is important that CCGs are not reincarnations of PCTs, as a genuine link to practices, which will allow reciprocal accountability, is the only way to guarantee a new way to commission services and produce real change.

The LMCs have recently produced guidance on how CCGs can be accountable to GPs and practices and we will be encouraging all of our CCGs to adopt our principles.  The ability to influence and change practice behaviour, whilst not actually holding practice contracts, will be a major goal for CCGs and this will only occur if the relationship is based on accountability and trust.  Changing the behaviour of the willing and supportive is possible, to attempt to achieve change without real practice sign up will be impossible.

One of the principles supported by both the Essex LMCs and the GPC is that all GPs in a CCG must be entitled to vote in elections of GPs to the CCG Board.  This includes partners, salaried GPs and locums and is designed to ensure that all general practitioners have an investment in the CCG and therefore it is more likely that proposed changes in clinical behaviour will be successful.  To expect to influence and lead a disparate group of highly independent clinicians, without allowing all of them to participate in the creation of the organisation, would be foolhardy.  How patients, other clinicians and practice managers will be involved is unclear, but it greatly increases the complexity of CCGs’ “governance”.

Although the LMC has spent a considerable amount of time with CCG leaders, and has put great effort into these early stages, it would be wrong to imagine that CCGs are going to function as democratic organisations.  They will always be primarily accountable to the National Commissioning Board (NCB) and as statutory bodies must account for public funds.  It is therefore an illusion to think they will constantly call for mandates from practices, or open up referendum style management of clinicians.  That is why it is important that the initial set up of Boards has a fair and democratic foundation, and that said Board are ultimately accountable in a meaningful way to constituent practices and clinicians.

CCGs will have some responsibility for the performance of practices.  It is not yet clear how this will be achieved, or how much of this task will be given to CCGs, but a “GP led” organisation which must address the performance of practices will be a new challenge for the LMC.

LMCs have existed for 100 years and it will be interesting to develop relationships with these new organisations.

BB