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GPs are less involved in CCG decision-making than practice managers

by Jenny Chou
9 September 2014

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• GPs are less engaged with clinical commissioning groups (CCGs) than practice managers

• Over 60% vote that healthcare has not improved as a result of CCG formation

• Practice managers say privatisation time frame is 2-5 years while GPs vote 5-10 years

GPs feel less engaged and are less involved in CCG decision-making than practice managers, a survey has shown.

The second annual survey of primary care NHS engagement of 1137 staff, carried out by Cogora, a healthcare research and publishing company, showed that while practice managers gave an average rating of three out of five for both how engaged they felt with their local CCGs and the extent to which they felt CCG decisions reflected their views, GPs provided an average rating of just two for both.  Nurses fell in between, providing a rating of three and two respectively.

And most survey participants believe that last year’s structural reforms have not led to improved care.  

Richard Vautrey, deputy chair of the British Medical Association GP Committee said: “Practice managers are increasingly the ones within the practice that are getting involved with the day-to-day CCG roles on behalf of the practice because GPs themselves are so overwhelmed with their practice commitments.”

He added that additional bureaucracy from the reforms on top of heavy workloads may have led to further feelings of removal when material changes were not enacted. There was a strong consensus among 60% of respondents, especially GPs, that quality of care has not improved as a result of the reforms. Instead, 80% of respondents said it has taken time away from patients, double the proportion predicting this would happen 18 months ago in the previous Cogora healthcare survey. 

“The vast majority of GPs don’t really believe that changes that have taken place have made a material difference. In many cases, the same GPs who were involved in clinical decision making in the form of primary care trust arrangements are now involved in the decision making of CCGs, and the vast majority of GPs are continuing as before.” said Dr Vautrey. 

“It sends a signal that the hugely expensive reorganisation has not made a material difference to the majority of GPs in many cases, but has actually added to their workload, not reduced it.”

‘Difficult to achieve’

The survey showed 97% of practice managers believe the reforms resulted in more work compared to a lesser proportion of GPs (91% ) and nurses (81%), especially in regards to paperwork.

Fiona Dalziel, co-lead of the General Practice Foundation at the Royal College of General Practitioners (RCGP) said: “I believe this will be because so many elements of the reforms require additional practice manager input and therefore this will have had a direct impact on their workload.”

Practice manager engagement was also reflected by their being most likely to believe the reforms had led to better relationships among local practices, which Dalziel said was a result of federation between general practices to deliver services, involving increased interaction with managers from other practices.

The survey also highlighted differences in practice manager and GP and nurse views regarding NHS privatisation. Practice managers felt it would take place in the next two to five years compared to GPs and nurses who thought it would happen in the next five to ten years. 

Vautrey said that given practice managers’ more direct role in CCG meetings, that they were more aware of how CCGs are putting services out to tender and that their estimate was “quite possibly” more accurate, signaling an even further removal of GPs from CCG decision making.

Commenting on what the differences between practice manager and GP CCG engagement highlighted in the survey means for dynamics within practices 

Vautrey said: “ I think ultimately it means that the aspiration of getting a clinically led decision making process will be difficult to achieve because the GPs don’t have the time to engage in decision making process in a way they would want to because of the difficulty in meeting the clinical needs of patients.”