The prime minister and health secretary have been warned that a third of clinical commissioning groups would rather not become statutory bodies because of the burden of bureaucracy involved.
Dr Michael Dixon, chair of the NHS Alliance, said that many frustrated CCGs would rather leave statutory obligations to other bodies and carry on commissioning as a “subcommittee”.
Under the Health and Social Care Bill, CCGs will be legally responsible for commissioning from April 2013, although ministers have said the NHS Commissioning Board will take over where CCGs were not ready, willing and able.
Speaking in Manchester at the HSJ Commissioning Forum North on 28 September, Dr Dixon said CCGs were increasingly frustrated at being told how big they should be, and the burden of complying with central requirements on corporate governance.
He said: “There is something really worrying at this moment, which I’ve had to warn Number 10 and the secretary of state about.
“Some CCGs are moving away from wanting to become statutory organisations, saying: ‘If we’re going to have to be enormous, and do all this stuff, and you’re going to set up lots of guidance, why on earth should we put our necks on the block? Why not leave all that stuff to someone else – the son or daughter of a primary care trust cluster, and we’ll carry on as a CCG advisory group, subcommittee of that future organisation?’
He added: “Almost a third countrywide are thinking of doing just that.”
Dr Dixon later told HSJ that if CCGs decided not to comply with the authorisation process, then a situation in which PCT clusters or the NHS Commissioning Board remain in charge could “drag on endlessly”.
But, he added, it would be better if all CCGs were statutory bodies, and that the obligations placed on them “don’t make everyone break out in a rash because of the enormous amount of red tape involved”. “The challenge to the commissioning board will be to loosen up,” he said.
Paul Wike, lead manager of Sheffield CCG, told the forum the biggest problem clinical commissioners faced was “all the other stuff put on our doorstep”.
He told the forum: “We can commission really well – it’s the bureaucratic stuff, the returns to the Department of Health, that will stop us doing what we do best.”
David Jenner, a GP involved in commissioning in Devon, said he has been angered by central guidance on 111 service procurement and Department of Health directions on extended choice of provider. He also said he was “passionate about commissioning” but anxious about CCGs taking on the risk of potential lawsuits.
“CCGs could have devolved responsibility for budgets but not the final accountability – we could still add real value without getting enmeshed in all the bureaucracy.”
But Steve Kell, executive chair of the Bassetlaw Commissioning Organisation, stressed the importance of public and corporate accountability, and emphasised the role of managers in the work of CCGs. He told HSJ: “Governance, audit, and patient involvement go with managing a budget… it’s not just GPs doing this on their own.”