Less than a quarter of the clinical commissioning groups created under the government’s NHS reforms will have GPs as their accountable officers, an HSJ investigation has found.
Despite the efforts of the government and the NHS Commissioning Board to urge CCGs to find clinicians to take up these roles, there has been a significant drop in the proportion planning to do so.
However, analysis of new information obtained by HSJ about the leaders of all 211 emerging CCGs shows that only 22 per cent have designated GPs for these roles.
These officers will become formally accountable for around £60bn of NHS spending when their groups are authorised by the commissioning board over the next six months. They will be responsible for their CCG’s duties, functions, finance and governance.
GPs close to the reform process said the dearth of clinical leaders in these positions of responsibility was down to a combination of systemic obstacles and a lack of GP interest in the roles.
The new figures show 72 per cent of groups have chosen a manager as their accountable officer - nearly all of whom are currently senior primary care trust managers. A further 6 per cent have picked managers who also have a nursing or midwifery background, or public health directors. Many more CCGs - 89 per cent - have GPs as their chairs. The remaining 11 per cent have lay chairs.
*managerial nurses, midwives and public health doctors
Since HSJ’s March report, the commissioning board has published detailed guidance about what is required of accountable officers. These requirements include extensive leadership skills and knowledge.
There has also been a national assessment process for accountable officers, and many CCGs have run appointment processes with the commissioning board represented on recruitment panels.
GP and NHS North East Essex designate accountable officer Shane Gordon is also a senior member of the NHS clinical commissioners representative group. He said the roles were much more similar to those of traditional PCT chief executives than originally intended, which did not appeal to clinicians.
Becoming an accountable officer would also mean GPs were likely to have to give up nearly all clinical practice, and therefore probably take a pay cut.
He continued: “There are a number of pressures in the system to maintain [existing] delivery and governance systems. Perhaps there is a lack of understanding [on the part of NHS leadership and the commissioning board] of the particular value of having a clinician in the leading role.”
He warned that medical revalidation, to be introduced later this year, would require doctors to carry out “quite a lot clinical activity”.
He said: “There is a real danger we drive them out [of leadership] through revalidation.”
Dr Gordon said the lack of GPs becoming accountable officers raised the “question of whether the NHS is serious about clinical leadership”. He added: “The challenge for the system is to increase the number [of clinical accountable officers] steadily over time.”
British Medical Association GPs committee member Chaand Nagpaul said a rapid CCG development timetable had forced some to choose managers rather than develop GPs.
“The [government’s] whole proposal was to have a very different complexion from PCTs. So we are concerned about it.”
Thirteen CCGs have no accountable officer in place, raising questions about whether they will be ready to commission from April.
A spokeswoman for the NHS Commissioning Board said: “We are pleased that so many clinicians have chosen to apply for leadership roles, whether as clinical chairs or a chief clinical officers, in CCGs.
“What is important is that there is a good mix of expertise in the broader leadership team, of clinicians and managers.”
HSJ’s analysis also found that just 18 per cent of CCG chairs were female - despite women comprising 46 per cent of the GP workforce and 39 per cent of GP partners, according to 2011 figures.
For accountable officers - many of whom are managers, including managers with a nursing background - there is more of a balance. The proportion of CCGs with a female accountable officer is 42 per cent.