A Department of Health adviser has said NHS national management, strategic health authorities and primary care trusts are misleading GPs about commissioning policy.
James Kingsland, Department of Health national clinical commissioning lead and a prominent GP commissioner, said senior figures were misrepresenting the DH’s advice and guidance about developing commissioning groups as new policy.
In general he said GPs were being told: “You can only work if you work like a PCT.”
Dr Kingsland told HSJ GPs in all regions were being told the government’s changes to its reforms meant emerging clinical commissioning groups had to change to be larger, have clear boundaries and be co-terminus with local authorities.
He said a rumour that funding for commissioning support would be as low as £20 per head of population – and a reason to form larger groups – was being repeated by managers as “gospel”.
Dr Kingsland said if these “interpretations” of policy proved correct he would abandon the reforms, adding: “If that is really the message in policy then we are in major trouble and haven’t got a chance. It would be difficult to continue to support it.”
He said one way misleading messages had been spread was the SHA assurance process. The process has taken place over the past few months, involves visits to each region and is led by NHS chief executive Sir David Nicholson.
Dr Kingsland said: “SHAs are now going out and saying, ‘This is how it is going to work’… It becomes de facto policy.”
HSJ has seen a discussion paper by Black Country PCT cluster which, sources said, was being seen as a misinterpretation of policy and over prescriptive. The paper says changed policy means there are new “design rules” for CCGs which were met by only one of eight emerging commissioning groups in the area. It suggests they should merge or form partnerships and mentions a proposal for a single CCG covering the whole cluster.
Black Country commissioning development director Andy Williams stressed the paper was for internal discussion. However, he told HSJ: “It was written to stop people wasting time and to focus on [structures] that are likely to get authorised [as CCGs]. We are not trying to make up national policy, but want to support people to get authorised.”
Details of the authorisation process are due to be published this month. BMA GP Committee deputy chair Richard Vautrey told HSJ he was concerned GPs were wasting time and effort on groups which would not be approved, and called for the authorisation process to given “clarity and standardisation” on requirements.