Future role of GPs in commissioning is ‘fragile’, report finds

Nearly half of all the GPs surveyed for a joint report by the King’s Fund and Nuffield Trust, shared exclusively with HSJ, also said they did not feel they had sufficient time to carry out their existing duties. The report includes a survey of 279 GPs and interviews with 72 GP CCG leaders.

The report warned of declining engagement from GPs with formal roles within CCGs and cuts to CCG management funding.

The findings come as NHS England is encouraging CCGs to take on responsibility for primary care. HSJ revealed last week that 77 bodies had submitted proposals for fully delegated responsibility for performance management and budgets of their member GP practices from April.

Despite this, few GPs involved in commissioning expressed a desire to performance manage their GP colleagues, according to the report.

• Third of CCGs apply for full co-commissioning powers over GP members
• CCGs consider swapping GPs to avoid conflict of interest

The report calls for CCGs to look at how they attract GP leaders, and for policymakers to provide sufficient finances to enable leaders to carry out their new responsibilities.

There was a fall in the number of GPs who reported being highly engaged in the work of their CCG, from 19 per cent of respondents in 2013 to 12 per cent in 2014.

“As their role in improving or developing primary care progresses, CCGs may struggle to find the capacity to take on new commissioning responsibilities in addition to their current commissioning work, and GP leaders will need to balance new roles with the pressure of their day to day clinical practice,” the report says.

It adds that “the role of CCGs will need to evolve” as the NHS comes closer to implementing the new care models proposed by the NHS Five Year Forward View.

“New larger providers may take on some of the CCGs’ responsibilities for coordinating local provision and planning services for their local populations’ health needs.

“Without structures that encourage innovative and critical input from clinicians, CCGs will not be able to achieve one of their original principles.”  

Nuffield Trust fellow Holly Holder, one of the report’s authors, said: “Our research shows that the future of the clinical role in commissioning healthcare remains fragile.

“While CCG leaders overall are still highly engaged in their work, our fieldwork and survey revealed this is waning and there are some worrying signs emerging over strained resources, both time and money.

“CCGs are set to be stretched yet further as they adapt to new and expanded roles… when co-commissioning takes effect - something that will test the resilience of GP members as they seek to manage inevitable conflicts of interest.”