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More GPs involved in their CCG but not enough, says King’s Fund report

14 July 2016

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GPs are more involved in their clinical commissioning groups (CCGs) than they were with previous forms of commissioning, according to a new report.

The Kings Fund and the Nuffield Trust conducted a survey in six areas of the country and found that more than 70% of CCG members were at least “somewhat” engaged with the work of their CCG.

The report, Clinical commissioning: GPs in charge?, says this compares favourably with engagement levels under practice-based commissioning, the previous approach to involving GPs in commissioning implemented in 2005.

However, the report also highlights concerns among GPs about their influence on commissioning decisions.

In 2016 only 20% of GPs without a formal role in their CCG reported that they could influence the work of their CCG if they chose to. This is down from 35% in 2014.

GPs also said they felt that CCG managers still had more influence over commissioning decisions than GPs and that there had been little or no change in the quality of care in general practice as a result of their CCG.

From the CCG perspective, the report says that they feel they need more autonomy in order to involve GPs in decisions about service design.

CCGs also said that inadequate resourcing is undermining their efforts to develop high-quality, clinically led commissioning and that there is a lack of political support when making tough decisions about priorities.

To address these barriers to GP empowerment The King’s Fund and Nuffield Trust are recommending NHS England “provide clinical leaders with the developmental support and training they need to do the job properly”.

The report is also advising the Government and NHS England to “outline a clear strategy for the future of commissioning support that recognises the likely changes in CCGs’ support needs over the next few years, as the role of CCGs changes”.

The report is also suggesting CCGs are provided with extra help on tough decisions “about how to prioritise funding, by being honest with the public about what is achievable with the money available.”

The report also has a list of seven “lessons for commissioners” in how to involve more GPs, including “engage with all GPs in a local area” and “maximise the contribution of CCG GP leaders”.

Dr Amanda Doyle, co-chair of NHS Clinical Commissioners said: “The King’s Fund and Nuffield Trust report rightly recognises the important role that clinical commissioners now play in the wider health system, and that they have matured and developed over the last three years bringing new and innovative approaches to better healthcare for their local populations.

“Their findings that CCGs have secured better clinical engagement from their wider membership than previous incarnations reflects what we’ve heard from our members.

“As a CCG leader and a GP myself I recognise the challenges and pressures that come with balancing both roles, and we know there is more to do to make sure even more GP colleagues and other clinicians feel able to actively participate in the clinical commissioning process.”

Ruth Robertson, a fellow in health policy at The King’s Fund, added: “The NHS must now build on CCGs’ achievements and do more to embed clinical involvement in planning decisions across the healthcare system.

“As well as properly supporting GP commissioners within CCGs, this means ensuring that GPs and other clinicians have a strong voice in the sustainability and transformation planning process and in the vanguards.

“Engagement with GPs and other clinicians is crucial to efforts to transform out-of-hospital health and care provision and to move the NHS to a more financially sustainable position.”

Holly Holder, a fellow in policy at The Nuffield Trust, also said: “Involving doctors and their colleagues in decisions about how NHS money is spent is very important. It won’t be possible to make the kind of changes at the front line we need to see without buy-in from people who actually deliver care.

“We are now moving into a complicated world of multiple and overlapping organisations taking on some of the responsibilities that GP-led clinical commissioning groups were given in the 2012 reforms. This must not mean diluting the voice of GPs and alienating those who have contributed to CCGs over the past few years.”