Under Simon Stevens, NHS England is willing to risk the disapproval of the British Medical Association and give commissioners greater freedom to challenge the status quo

The virulent response from the British Medical Association to NHS England’s decision to allow GPs in Somerset to break away from the national quality and outcomes framework is not just an overreaction. It is a signal the doctor’s union sees the move for what is – a test of what is permissible within the new commissioning structures for individual clinical commissioning groups, and therefore a challenge to their power as a national negotiating body.

‘The uneasy relationship between the BMA and “clinically led” CCGs is deteriorating’

Although NHS England has been clear that other CCGs will not be allowed to follow suit this year, it is also quite content for it to be interpreted as a sign that its chief executive, Simon Stevens, is keen to allow groups greater freedoms where appropriate and deserved.

A united front

The idea for the move came from Somerset CCG, but it was also championed by the NHS England area team. When these two voices speak together from within a, mostly, strong health economy like Somerset’s, NHS England will be keen to back the united front. QOF is not only area in which this kind of change may be felt.

The briefing against granting Somerset freedom on QOF described the decision as “naive” and forecast it would end in tears. Time will tell. What is clear is the already uneasy relationship between the BMA and “clinically led” CCGs is deteriorating further as the union draws increasing attention to the apparent distance between groups and “frontline GPs”.

NHS England appears to understand and accept the risk of BMA disapproval – and may ever consider it an advantage as it increasingly seeks to position itself as a challenger to the status quo.