One of the key aims of establishing clinical commissioning groups (CCGs) in England’s NHS was to place general practitioners at the heart of NHS commissioning. And yet surveys consistently show that many GPs feel that their view are ignored by their CCGs. For example, an NHS England survey reported that only 44% of GPs said that their CCGs acted on their views. A BMA survey reported that nearly two-thirds of GPs feel they either had limited influence on their CCGs or that they were dictated to by their CCGs rather than being asked to contribute to CCG decision making.
Another key aim of creating CCGs was to make use of GPs’ clinical expertise in commissioning health services to improve health outcomes and patients’ experience of the NHS. However, a Pulse survey found that more than twice as many GPs think that the introduction of CCGs has been detrimental to patient care than think have improved it.
In many ways, the fate of CCGs is linked with inextricably the consequences of the 2012 Health and Social Care Act that created them. The disruption caused by the changes the Act brought about, at a time when the NHS was entering a period of unprecedented financial pressure, have clearly made it difficult for both GPs and CCGs to function effectively. One example of this was the transfer of key public health functions to local authorities – rather than to CCGs – when primary care trusts (PCTs) were abolished. GPs suddenly found themselves with little or no influence in determining local policies for services in areas such as smoking cessation and sexual health.
Many GPs have worked very hard to try to ensure that CCGs delivered what they set out to do when they were established. They will argue that the financial pressures on the NHS - and the declining share of the NHS budget spent on primary care along with the large increase in workload that primary care teams have experienced in recent years – that are largely responsible for the perception among many GPs that CCGs have failed to achieve their key objectives. But it is CCGs who now control the majority of NHS funds in England and they could have done more to protect and expand primary care services, and taken a stronger line against the demands of NHS hospital trusts.
What does the future hold for CCGs? The Chancellor, George Osborne, has recently stated that major cities in England will be offered the opportunity to control their health budgets. GPs were not consulted about this proposal which will effectively remove from many CCGs much of the influence they currently have in commissioning NHS services. Other CCGs have opted to take on the co-commissioning of primary care services in addition to secondary care commissioning, effectively recreating PCTs (but still without responsibility for key public health functions). To prevent conflicts of interests, the role of GPs in CCGs that take on co-commissioning will have to be carefully regulated.
Hence, in many parts of England, we will start to see the end of GP-led commissioning. GPs will continue to have a role in commissioning health services but increasingly this will be an advisory rather than a leadership role
A version of this article was first published in Pulse.