Transforming primary care
In addition to their commissioning responsibilities, CCGs have a legal duty to support quality improvement in general practice. Transforming primary care may be one of the main challenges for the majority of CCGs particularly given that there is little information about how this can be achieved. The recent King's Fund report pointed out the difficulties in defining the role that CCGs have, and reported whilst most of the CCG leaders involved in that research accepted that CCGs need to play an active role in primary care development, there was unease about the difficulties in performing this role appropriately. The report also found that many GPs were unclear about the authority that their CCG had over them. The report concluded that the active role CCGs will need to play in facilitating change in primary care is a contentious issue, although the debate is not whether they have such a role but rather how they go about it. The report also points out that it is concerning that there is still confusion about how the responsibility for quality improvement in general practice will be shared between CCGs and NHS England area teams, and suggests that the risk is that neither organisation will perform the role effectively.
A recent Pulse article points out that a contradiction in the Health and Social Care Act means that whilst CCGs have a responsibility for quality in primary care, they have no say over GP contracts in order to avoid potential conflicts of interests. This has caused confusion about CCGs’ roles in relation to primary care. According to the article, commissioning leaders are clear about how the situation should be changed. Julie Wood, interim commissioning development director at NHS Clinical Commissioners, says the organisation is backing a change: ‘We feel that CCGs need to play a key role in the commissioning of primary care’. She suggests that CCGs holding GP contracts in addition to the primary care budget could be part of a solution: ‘It could be either that the CCG does most of the commissioning of general practice while GP contracts sit with NHS England – or you could go the whole hog.’ However, Dr Nigel Watson, chair of the GPC’s commissioning subcommittee and a member of NHS England’s GP strategic commissioning group, suggests that CCGs can develop the control that they need over primary care without taking over GP contracts. He commented that ‘I think it’s inevitable that CCGs will take on more of a role in primary care. It’s part of the solution to the “silo mentality” in the health service. With the crisis that general practice is going through in terms of workload and recruitment, CCGs could be part of the solution allowing practices to work together in bigger units’.
In their Improving general practice – a call to action consultation, NHS England have acknowledged a role for CCGs in planning primary care, and said general practice needs to be more flexible and locally responsive to CCG agendas.