The British Medical Association GPs committee chair is “becoming increasingly alarmed” by how clinical commissioning groups are developing, he has said in a letter to GPs.

In an open letter published today, Dr Laurence Buckman says: “While there are good things happening in some areas - GPs, supported by managers, are becoming more involved in the planning and delivery of healthcare and there is greater working with our consultant colleagues - I am becoming increasingly alarmed by the manner in which some [clinical commissioning groups] are being established and are operating.

“There is a limited window of opportunity left for us, as your national representatives, and you, as practising GPs, to influence the development of CCGs, and that is why I am writing to you now,” he says.

The letter comes four days before the second reading of the Health Bill in the Lords, at which some are expecting peers to challenge the government further on its proposals.

Dr Buckman says he is concerned about “places where there has not been any adequate democratic opportunity, or where not all GPs have been included” in developing CCGs. He also raises concern that in some places CCG board members “have put in place untried and unacceptable measures to micro-manage practices, irrespective of the views of local GPs”. Additionally he writes that “in some areas the LMC [local medical committee] is being sidelined and ignored”; and “it is appearing increasingly likely that the authorisation process… will only authorise organisations that bear a remarkable resemblance to PCT”.

He says: “I am very concerned by reports I am getting from GPs who do not feel engaged with the changes happening in their area, or feel they have not been given opportunity to be involved; it is vital in the early days of a new NHS in England that it is the many and not the few who influence important formative decisions.

“The changes to health services in your area are happening now, regardless of the bill’s passage through parliament. I have set out our primary concerns below and would urge you to make sure your voice is heard locally, not just if you have concerns, but so you can help shape the future of healthcare in your area.”

Dr Buckman says: “However, when it comes to the development of CCGs, we believe democratic accountability and collaborative working with constituent GP practices, including all sessional and salaried GPs, is vital.

“We must learn the lessons from practice based commissioning: where there has been active engagement of grassroots GPs, greater positive change has been achieved; where it has not it has failed to deliver and, in some cases, has damaged existing services.

“Your LMC, working with the BMA, has a long history of representing GPs’ interests, having been in existence through 100 years of NHS reforms; its organisational memory and role, both statutory and none statutory, is even more important today than it has ever been.”

He asks GPs to contact their local LMC with concerns about the process.

In relation to the Health Bill, Dr Buckman highlights particular concern about the “enforced roll-out of the ‘any qualified provider’ policy”, and says, “we remain seriously concerned” about the proposed “quality premium”, which would pay CCGs or GP practices additional funds based on performance.