The clinical commissioning groups taking on full control of GP services in their area this week will be responsible for performance managing poor practices and approving practice mergers, according to documents seen by HSJ.
However, NHS England will continue to have responsibility for complaints management, according to the delegation agreement it sent to CCGs and seen by HSJ. This comes in spite of guidelines issued by NHS England last year stating that this responsibility would be passed onto CCGs.
Sixty-four CCGs have been approved to take on fully delegated commissioning of GP services in 2015-16.
Several group leaders previously told HSJ they were concerned about the lack of time they had to prepare to take on co-commissioning responsibilities.
CCGs were issued their delegation agreement just two weeks before they were due to take on additional powers. HSJ understands that they were given only one week to sign and return the agreement, but this was pushed back by two days following concerns being raised by some groups.
The delegation agreement is near final confirmation of the responsibilities that will pass to the CCGs. It states that CCGs will make “decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the [Care Quality Commission] where the CQC has reported non-compliance with standards”. This will exclude any decision relating to performers lists or individual GPs, which NHS England will continue to have responsibility for.
CCGs will be responsible for making decisions on local GP incentive schemes, “including the design of such schemes”, and on the establishment and closure of GP practices in their area, including the approval of practice mergers. They will also make decisions surrounding enhanced services, “discretionary” payments and about commissioning urgent care for out of area registered patients.
However, the agreement states that “functions in relation to complaints management” about practices or GPs will be retained for NHS England. This is a change since previous guidance. It is understood some had raised concerns with NHS England about the practical implications of moving complaints handling, as well as the risks involved in GPs’ conflict of interest.
The agreement does state, however, that NHS England could ask CCGs to carry out some elements of processing complaints in the future.