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Will CCGs take full control of general practice?

by Léa Legraien
25 October 2017

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All 207 Clinical Commissioning Groups (CCGs) could be in charge of primary care from April 2018.

NHS England wants the majority of CCGs to apply for full delegation, on the commissioning of GP practices’ services, before 1 November.  

Enhancing primary care

In a document describing the application process, NHS England wrote: ‘The delegated commissioning model is delivering a number of benefits for CCGs and local populations.

‘It is critical to local sustainability and transformation planning (STP) supporting the development of more coherent commissioning plans for healthcare systems and giving CCGs greater ability to transform primary care services.’

Under the delegation, CCGs can establish new practices, approve mergers and are in charge of ‘discretionary’ payments.

They also manage the three types of NHS contracts, General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS), and enhanced services, including Local Enhanced Services (LES) and Directed Enhanced Services (DES).

In 2017/2018, 174 CCGs agreed to have delegated commissioning arrangements, which represents 60 more CCGs than in 2016/17.

Primary care co-commissioning is part of a series of changes set out in the NHS Five Year Forward View.

Risk or reward?

In 2015, the King’s Fund conducted a study on the role of CCGs in general practice.

Researchers found that, as CCGs build trust with practices, they are are best placed to support them and develop a sustainable primary care system for the future, which can lead to financial savings in secondary care.  

However, the report also outlined that the extended role of CCGs in practices could create ‘conflicts of interest, reductions in running cost budgets and strained relationships with fellow GPs and NHS England’.

NHS England argues that delegating commissioning is the key enabler of the development of new care models, as it offers a better patient care experience and improves CCGs’ relationships with practices. 

Graham Foulkes, vice chair of Oldham Primary Care Commissioning Committee (PCCC), said: ‘If a practice is struggling, we are able to put a support package in place to help them really quickly. The practices appreciate this.’

NHS England will review all CCG applications in January 2018.