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Many GPs disengaged from work of their local CCGs

Poor sense of collective belonging and ownership, suggests study

Caroline White

Tuesday, 23 July 2013

Many GPs in England don’t have a strong sense of ownership of their local clinical commissioning groups (CCGs), suggests a snapshot of current practice in six CCGs, published jointly by the Nuffield Trust and The King’s Fund.

Member GPs are less likely to believe that their CCG is “owned” by them than the leaders of those CCGs, suggests the report, which is one of the first to assess the early experiences of CCGs.

This low level of engagement risks undermining one of the plinths of the healthcare reforms, which saw responsibility for the majority of the commissioning budget for healthcare in England handed over to 211 membership CCGs, indicates the report.

GPs back what CCGs are trying to achieve, but many of those involved in the study felt that decisions being taken by their local CCG did not always reflect their views, the findings show.

The report is based on six case study CCGs, and is the first report to come out of a three year joint project by The King’s Fund and the Nuffield Trust, which will look at how clinical commissioning is evolving in the new health care system.

It highlights significant variation among different CCGs, with levels of member ownership and involvement much higher in some areas than in others. Larger CCGs, in particular, may struggle to engage GPs and create a culture of collective ownership, the findings suggest.

The report also found that most GPs believe CCGs have a legitimate part to play in trying to influence the clinical behaviour of local GPs, but there is some wariness of the form that this will take.

It isn’t clear how responsibilities for primary care development will be divided among CCGs and the new national commissioning board, NHS England, says the report, which calls for this to be clarified.

Chris Naylor, a Fellow at The King’s Fund, said: "CCGs have a real opportunity to get clinical expertise into the heart of decision making. Our research suggests that there is a lot of goodwill in general practice towards [them], and there is a general wish for CCGs to succeed.”

He added: “It is important that CCGs seize the opportunity to build on these positive first signs of engagement and develop strong relationships with their membership, so that they can help general practice evolve and respond to changing needs."

Holly Holder, Fellow in Health Policy at the Nuffield Trust said that there was a great deal of support for the aim of CCGs to become locally driven decision-making bodies that provide better care for their populations.

But she cautioned that in order to meet that aspiration, “CCGs will have to sustain the support of their membership and demonstrate how participation from local GPs adds real value to their work. CCG leaders should know which areas of clinical practice GPs perceive to be legitimate spaces for CCGs to influence, and which strategies could risk disengagement."

The report argues that CCGs will need to strike a careful balance if they want to influence primary care practice without alienating their GP members, on whom they depend for their legitimacy.

There is a clear danger of repeating the same mistakes as previous attempts at clinical commissioning if CCGs fail to bring about service changes that win the support of their member within an acceptable timeframe, it suggests.

The Nuffield Trust and The King’s Fund are therefore calling for CCGs to prioritise strengthening connections with members and using these relationships to help shape and improve GP services locally.

CCGs should focus on creating a governance structure that supports the involvement of local clinicians in decision-making and delegates power where appropriate, the report recommends.

And they should clarify the roles of member councils, locality groups and the governing body, and ensure that those involved understand what authority and responsibilities sit at each level.

Furthermore, CCGs should spell out what their role is in supporting quality improvement in primary care, explaining where this role begins and ends, and how the CCG will work with the NHS England local area team.

And they should support peer to peer dialogue and performance review in small groups, particularly through face to face meetings, ensuring that members understand the most important elements of the CCG’s constitution, says the report.

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