‘Specialist’ doctors on CCG boards could be GPs

The government’s original NHS reforms would have allowed commissioners to decide their own governance arrangements.

But earlier this month, in what was seen as a major concession to those worried about other clinicians being excluded from commissioning, the government announced that it would stipulate all CCGs must have one “doctor who is a secondary care specialist” on their governing boards.

However, the place for acute doctors on boards will not be written into legislation, instead a regulation will be introduced to specify the make-up of boards. A briefing paper accompanying amendments to the Health Bill said the government “intended” this power to be used to specify that boards have a nurse and “one doctor with secondary care experience”.

HSJ understands this means the doctor does not have to be currently working as a specialist and may be a GP.

It will be up to commissioning groups to decide who sits on their boards, although the NHS Commissioning Board will monitor board development through its authorisation process.

Health secretary Andrew Lansley has suggested that retired clinicians or those working outside of the area could be suitable for the positions as they would not have conflicts of interest borne by those working for local providers.

British Medical Association consultants committee chair Mark Porter said: “There are no GPs who don’t have secondary care experience. They have all done part of their training in hospitals.”

Dr Porter also said the proposal to require a specialist to sit on a board amounted to “tokenism” and would not secure good engagement, as the individual may be uninterested and “nod through” the CCG’s plans.

Department of Health national clinical commissioning network lead James Kingsland told HSJ that the government’s intention was always to take “an inclusive multidisciplinary approach” to commissioning.

He said prescribing a specialist on boards was a “very mechanistic way to demonstrate that”.

But, he said, the flexibility was welcome: “It is that balance between having some consistent standards with having local decision making.”