The government has not yet decided whether clinical commissioning groups can take on management of general practice contracts, the responsible Department of Health has said.
Director of primary care policy Ben Dyson was speaking at a session at the NHS Confederation conference in Manchester today.
Under reform plans the NHS Commissioning Board will be responsible for commissioning primary care, however the government has said it wants to delegate some elements to local clinical commissioning groups.
Mr Dyson said GPs themselves must lead improvements in primary care. He said: “The commissioning board will be responsible for commissioning primary care.
“That appears to create a contradiction. How can the board – a fairly remote body – commission primary care when the real job of quality improvement needs to go on within general practice and across general practice?”
However he said many elements of auditing and improving performance could be done by commissioning groups while elements like “setting terms and conditions and contracts, deciding when to bring in new providers or tackling breach of contract with existing providers”.
But Mr Dyson said there are some tasks which it is not yet clear if they can be delegated by the commissioning board to CCGs or not.
He posed the question: “How would [CCGs] be given a more formal role in reviewing performance and seeing how far GP practices are meeting the terms of their contract? Is that a job for the commissioning board or could most of it be delegated?”
Mr Dyson said the DH was working with emerging CCGs in some areas of the country to test approaches.
At the same session, King’s Fund senior policy fellow Nick Goodwin said he feared that the commissioning board would not be able to replicate local incentive schemes which primary care trusts have used to improve GP services; while CCGs would not be able to make the payments because of the potential conflicts of interest.