Reaction: Move to CCG role in primary care splits opinion

The NHS England chief executive has announced - only a month after he took up the role - an apparently bold move that will allow CCGs to co-commission the services. HSJ asked commissioners and other healthcare leaders their reaction.

Su Long, Bolton CCG chief officer

“We need transformation and delivery from general practice to achieve what we [as a CCG] want to do. We need some form of contractual come back [on member GPs].”

She said the powers would be used to “commission for higher standards” “higher quality and reducing variation in general practice”.

Ms Long said conflict of interest would not be a problem if it was “handled in the right way”, and investment decisions are “authorised by NHS England”.

Chris Ham, King’s Fund chief executive

“There is a strong argument for closer involvement [of CCGs] in commissioning primary care care. The ability of [NHS England] area teams to do it is very variable. We see a lot of benefits in what’s now being proposed.”

Chaand Nagpaul, British Medical Association GPs committee chair

“At the moment the proposals… are a departure from the philosophy of [clinical commissioning groups] being small membership organisations with a connection with individual GP practices.

“We need to make sure in the process of this that we don’t end up with restructuring at the expense of organic change and engagement of GP practices.

“We do not support CCGs in any way holding or managing individual GP contracts. We see no logic or need to do this. The aspirations of NHS England in terms of the co-commissioning of primary care do not need the GP contract to be managed by CCGs.”

Hugh Reeve, Cumbria CCG chair

“Right from the point that CCGs were established I had been arguing that splitting primary care commissioning… from the rest of community services and normal hospital commissioning was not sensible.
“[If] other organisations like community trusts or hospital trusts want to take on general practices that are really struggling… there is logic to them only having to deal with one commissioner.”

Dr Reeve said taking on a formal role for primary care would mean CCGs could “support general practice to become more robust in terms of its business model”, and that where they “come up with a proposal that we think is the best for the local population, there will be no reason why that will not be approved”.

Howard Freeman, Merton CCG and London GP Commissioning Council chair

Dr Freeman said it was “inevitable” that giving CCGs primary care responsibility would lead to the reduction of GP influence as it had when primary care groups took responsibility for primary care in the late 1990s and early 2000s and became primary care trusts.

“At the moment we’ve got lots of GP engagement. There’s no noise about GP disengagement. Once you start going down the route of commissioning GPs, you get into the money [for GPs] argument and the performance [of GPs] argument.”

Sam Everington, Tower Hamlets CCG chair

“There is a great sense that this what we need to do

“We will be less successful if we have to focus on the pure performance management. What we’re very happy with is a developmental role, which is about improving standards in general practice generally.

“If we had to do the performance management there’s a risk that would lose confidence with some of the members. You need a level of [independence from GPs] to be managing that.

“That’s a role that is very well performed by the medical directors in NHS England and the [Care Quality Commission].

“We’re used to dealing with [counteracting conflicts of interests] within our CCG.”