Some clinical commissioning groups have told HSJ they are preparing to take a leading role in redesigning primary care, amid what they called a “hiatus” of action from NHS England.

Several CCGs said they were developing plans for the future of primary care in their areas, which they want to be signed off by their local health and wellbeing boards, and NHS England local area teams.

Under the Health Act, NHS England holds general practice contracts. However, CCGs also have a responsibility for helping improve primary care quality.

The arrangement is designed to avoid GP-run CCGs having a conflict of interest in being both provider and commissioner. However, it leaves CCGs’ role in relation to general practice unclear.

A source at a CCG in the south, which is planning to significantly change how acute care is provided in its county, said it was also planning to become the de facto primary care commissioner.

It plans to lead the redesign of incentives for GP practices, to encourage practices to federate and provide some services on a networked basis. The work is considered necessary to support its system-wide changes. GP commissioners believe they are closer to local practices and have more capacity to enact reforms than NHS England’s local area team.

In the north, a CCG source told HSJ of a “power struggle” between CCGs and the local area team, as CCGs feel they should be involved in primary care commissioning as they have more credibility with GP practices and are therefore better placed to make the case for change.

CCGs in Berkshire are proposing to organise a workshop session with NHS England in the autumn to look at the future development of primary care in the area. The session would consider how primary care can cope with the demands of caring for an aging population, increasing numbers of patients with long term conditions and rising demand for urgent appointments.

Bassetlaw CCG chair Steve Kell, also co-chair of NHS Clinical Commissioners leadership group, said CCGs were stepping up because there had been a “hiatus” in primary care commissioning since NHS England took over in April. He said many local area teams were doing little more than contract management, rather than active commissioning.

He said general practice needed a focus, which would require input from both CCGs and NHS England.

He said: “If we are going to genuinely drive forward integration and improved patient care, primary care is an essential part of that.”