Some clinical commissioning groups have appointed lay people with insufficient experience and skills, patient leaders have said.
Under the Health Act CCGs are required to appoint at least two lay members on their governing body – one with particular responsibility for governance and one for patient involvement.
Primary care trusts, their predecessors as local commissioners, are required to have a majority of non-executive directors on their board – generally they had around six.
A review commissioned by the Department of Health and published earlier this month, called Embedding patient and public engagement in CCGs, looked at a small number of emerging CCGs to examine what support they needed to strengthen involvement.
It highlighted concern about the experience and skills of some lay members, how they had been appointed, and the support and payment provided.
The report by consultancies the Moore Adamson Craig Partnership and InHealth Associates said: “Some CCGs provided them with contracts specifying remuneration, others with expenses and others with nothing at all.” It said the “roles need to be understood, supported, developed and rewarded”.
It said some CCGs had taken lay representatives directly from practice participation groups run by member GPs, whereas others had run an external recruitment process. Some CCGs believed PPGs were “too parochial, introspective and ‘set in their ways’” to provide lay members and be their main engagement mechanism.
Some are concerned CCGs may choose lay members who act as champions for them rather than challenging decisions.
Appointments of PCT non-executive directors were overseen by the Appointments Commission, which was abolished in October.
Andrew Craig, one of the authors, said: “No one actually knows how [lay members] have been appointed [across the country]. They certainly should be independently appointed.”
He said the role of lay members – particularly their balance between providing governance oversight and patient involvement – was unclear. “Those who are going to be successful are going to have to make it up as they go along,” he said. He called for the NHS Commissioning Board to provide support and guidance to CCGs, particularly on how they can measure their success in engagement.
Mr Craig said creating a network for CCG lay members may also strengthen their role.
National Voices policy director Don Redding told HSJ: “Some CCGs will have drawn lay people from their PPGs. In our view there is a fundamental development task required here to help PPGs move from ‘friends of the practice’ to ‘critical friends’.”