There is huge variation in the sums clinical commissioning groups have paid in salaries to GPs for their involvement, HSJ analysis has revealed.

The research, based on an examination of the 2013-14 annual accounts of all 211 CCGs, suggests they spent at least £58m on the CCG work of chairs and other GPs in total in that year.

Sums paid in salaries and fees declared in the accounts ranged from £905,000 by East and North Hertfordshire CCG to Hardwick CCG’s £25,000 - a 25-fold difference.

There was concern during the introduction of GP-led commissioning, under the government’s reform programme, about the cost of involving GPs. The analysis suggests there has been a steep increase in the cost of clinical input compared to that for primary care trusts, which CCGs replaced in April last year, although no direct comparison can be made due to reporting differences.

CCGs’ total spend on chairs and other GPs’ salaries and fees was £58m. This underestimates the total cost as it does not include compensation paid by some CCGs to practices for GPs’ time.

In 2012-13 PCTs spent £25m on their professional executive committees, whose members were clinicians. They spent a further £14m on chairs and non-executive directors, which were very rarely GPs.

Reasons given to HSJ by the CCGs paying the most to GPs included their large populations, representation for their separate localities, and possible reporting differences.

East and North Hertfordshire CCG chief finance officer Alan Pond said: “To ensure we maintain a local focus we have a strong locality structure in place whereby all GP chairs and vice-chairs of our localities have a place on our governing body - 15 GPs in total.”

ccg budget

Leicester City CCG chair Azhar Farooqi said it was “very important… that we developed good relationships with our member practices to ensure our commissioning decisions reflected [the area’s] diversity and poor health”.

Sandwell and Birmingham CCG accountable officer Andy Williams said its “clinicians [were] paid at rates set with reference to those paid nationally for medical sessions and approved independently of GP directors”.

CCGs that paid the least stressed to HSJ that they still had strong clinical involvement.

Rushcliffe CCG chief officer Vicky Bailey said it had a “clinical cabinet [which] means GPs from [the CCG’s] wider areas can have a voice”.

Hardwick CCG accountable officer Andy Gregory said it paid some GPs on a sessional basis, which was not reported as salaries and fees in accounts.

National Association of Primary Care chair Charles Alessi, who has championed GP-led commissioning, said wide variation was probably due to CCGs’ differing governance and management.

He said they “have different ways of working” and added: “In some places the natural leaders are the general practitioners, in which cases clearly the remuneration follows that.

“In some other places management is a little bit more prominent.”

Dr Alessi said it was “absolutely essential [to] ensure that the amounts which are expended are value for money”, with “proper transparency and proper systems [for deciding payments]”.

Topics