GPs occupy just a quarter of accountable officer posts in clinical commissioning groups, a comprehensive survey by HSJ has revealed.

The finding comes amid warnings that CCGs will struggle to boost the number of GPs in leadership positions or to replace those who leave.

The analysis of all 211 CCGs shows one in 10 GPs who took on chair or accountable officer roles when CCGs went live have since left their posts.

GPs were far more likely to be chair than to be accountable officer, the research also found. More than eight in 10 CCG chair positions are currently held by GPs.

GPs in leadership roles

The study also found that a higher proportion of women held top officer positions than led boards. Two-fifths of accountable officer positions were occupied by woman compared with one-fifth for CCG chairs.

Vicky Pleydell, chief clinical officer for Hambleton, Richmondshire and Whitby CCG, said there were probably not many GPs with enough management experience to take on the accountable officer role.  

“You certainly can’t just go from being a GP in a practice to being accountable for what is a big organisation with a large budget,” she said.

Dr Pleydell said it could be difficult to balance the workloads of CCG leadership and frontline general practice. She stopped practising as a GP in April last year to focus entirely on commissioning commitments. “You’re accountable 24/7 and you need to be available to your organisation every day,” she said.

“It’s very hard to do that alongside a clinical role that needs your entire focus whilst you’re doing it.

“I think it is more practical to keep going in a clinical role if you’re a [CCG] chair.”

She pointed out that many female GPs already worked part time, making it even more difficult to split their time between clinical and leadership roles. To split a part time role “into two part roles” can be “quite difficult to manage”, Dr Pleydell added.

Mark Hayes, chief clinical officer of Vale of York CCG, said GPs may be more interested in heading new provider organisations than commissioning groups.

GPs are being encouraged by officials to consider extended provider models which would see practices work more closely by forming federations or larger, single organisations.

“If we’re going to get the change that we need [in general practice] you need strong leadership,” Dr Hayes said.

There would “probably be a rebalance” in which “some of the leadership in commissioning [moves] into the provider landscape”, he added.  

Richard Vautrey, deputy chair of the British Medical Association’s GP committee, said huge pressures on general practice made it “very difficult” for GPs to take on extra work.

“They see the huge workload that their colleagues [in CCGs] have had to bear,” he added.

Dr Vautrey suggested it would be “difficult to find successors” to existing CCG leaders. “[There] doesn’t appear to be large numbers of GPs willing and able to step forward and take on these roles as and when CCGs chairs and executive officers stand down.”

Exclusive: Troubled CCGs could face 'special measures' regime