GP practices look set to be handed an extensive role in performance managing each other – including through the award of bonuses – under proposals being drawn up by the NHS Commissioning Board.
The commissioning board will hold primary care contracts from April 2013. However, clinical commissioning groups also have a duty under the Health Act to “assist and support” the board in improving the quality of primary care.
HSJ understands the board’s operating model for commissioning primary care – due to be published in coming weeks – will indicate significant parts of the work are to be passed to CCGs.
The moves will risk accusations of conflicts of interest among GPs managing and rewarding each other. But the commissioning board believes some emerging CCGs have begun strong attempts to improve members’ services and performance, senior NHS sources said.
The operating model, as well as setting out how the commissioning board will work, is therefore likely to identify the “levers” CCGs will themselves have for developing and improving primary care.
These include paying practices to provide new services, and paying incentives under the “quality premium” performance bonus included in the Health Act.
Under the premium, it is expected the commissioning board will be able to pay sums to CCGs dependent on performance on quality indicators and financial requirements.
The government will publish secondary legislation including rules for the premium in coming months.
HSJ understands details have yet to be agreed, but it could restrict how CCGs can use the money and split it between practices.
CCGs will either be able to use the funds to develop new services, give practices money to develop their services, or pay practices money with no conditions attached.
Under the approach to primary care commissioning being developed, CCGs would also be expected to benchmark and monitor practices’ performance, and potentially refer them to the commissioning board to take contract remedial action when there are serious problems.
King’s Fund senior fellow Nick Goodwin said allowing CCGs to commission new services which “wrap around” practices was “entirely legitimate”, although asking CCGs to manage members could create conflict in areas where relationships were bad.
The British Medical Association’s GPs committee has already highlighted concern about CCG performance agreements among practices.
Chaand Nagpaul, GPs committee negotiator with responsibility for commissioning, said: “We need to be careful contractual matters are not managed by the CCG – it would be inappropriate and there would be a conflict of interest.”