Clinical commissioning groups will be free to allow GP practices to move off the national GP pay for performance framework and to create new contract arrangements, under NHS England’s plans for co-commissioning.
HSJ understands national guidance on CCG co-commissioning of primary care will allow areas to follow Somerset, which earlier this year ditched the quality and outcomes framework for many of its GP practices.
The Somerset move was controversial and the British Medical Association warned it could spell the “Balkanisation of national healthcare”.
An NHS England board paper, to be presented at its meeting on Thursday, states that CCGs approved to take on delegated responsibility for general practice will “have the ability to offer GP practices the opportunity to set the strategic direction for quality by providing a locally commissioned service or participating in a locally designed incentive scheme”.
CCGs have been asked to resubmit bids to co-commission early next year. They could take on the powers from April.
The board paper also suggests CCGs would be free to agree other variations to local contracts with GP surgeries and potentially new contractual forms, if the practices were willing.
The paper states: “Any migration from a national standard contract to a local contract could only be affected through voluntary action.”
NHS England would check arrangements through its CCG assurance process and would set “national standing rules” that must be followed in contracts.
“The standing rules would become part of a binding agreement underpinning the delegation of functions and budgets from NHS England to CCGs,” the paper says.
The board paper sets out requirements to mitigate conflicts of interests in CCGs, which are meant to be controlled by GPs. It says they must create “decision making committees” with a lay chair and in which lay and executive members form a majority, rather than GPs.
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Healthwatch and local authority representatives will have the right to observe the committee. The rules will form part of detailed guidance to be published on Monday.
The British Medical Association’s GP committee deputy chair Richard Vautrey said giving the responsibility to CCGs, and reducing GPs to a minority in decision making, was “another step towards recreating [primary care trusts] which previously held general practice contracts and had the power to vary them through [locally agreed] personal medical services and alternative medical provider services [contracts]”.
He said PCTs, despite having that power, chose to stick with national contracts. He said “the core elements of general medical services and PMS [contracts] should be seen as a foundation on which to build not to undermine”.
“The focus should be on what other new resources can be identified for expanding community activity, not being limited to the relatively small and falling resource general practice already has.”
Vale of York CCG chief clinical officer Mark Hayes told HSJ that departing from QOF would be an “enabler” to “help us move away from where we are to the new models of primary care outlined in the NHS Five Year Forward View”, published last month.
Dr Hayes said: “If you’re going to have the innovation [and] transformation that we need… then at any point in time there will be some areas which are ahead and developing faster than others. That’s where having the flexibility to have a local contract is useful.”
He added that in order to “move away from… the 1948 model of primary care, we need to experiment [and] test some change in some places, and the way that you do that is by testing different models of money flowing around the system”.