Consultants are concerned about input of secondary care to CCGs

Most consultants are dissatisfied with the level of involvement of secondary care in their local clinical commissioning group (CCG), a survey by the BMA has indicated.

More than three quarters (77%) of the 284 consultants surveyed by the association said that they were not happy with the degree of secondary care input to their local CCG. Almost a 10th (8%) said that they knew of a local CCG that had no input at all from a secondary care clinician.

Nearly all respondents (90%) believed that involving secondary care doctors was important for effective commissioning, and 75% agreed that CCGs communicated well with doctors in secondary care. But less than two thirds (61%) of consultants believed that CCGs sought the views of secondary care doctors.

CCGs are legally required to have a secondary care specialist on their governing board. However, the boards cannot appoint secondary care doctors who are an employee or a member or partner of one of the providers that the CCG commissions, ruling out doctors at local hospitals. The BMA has previously described this system, designed to prevent conflicts of interest, as “hugely problematic.”1

In total, 71% of consultants surveyed by the BMA were not confident that their local CCG had adequate measures in place to manage potential conflict of interests among secondary care doctors on the board. The consultants surveyed also saw the system for appointing secondary care doctors to CCGs as a problem.

Two thirds (66%) of respondents were unclear as to how secondary care doctors were recruited to their local CCGs. Fifteen per cent of respondents were aware that an open interview process was used to recruit secondary care doctors, and a similar proportion (12%) said that untested appointment was used.

Tom Kane, deputy chairman of the BMA’s Consultants Committee, said he was concerned at the lack of transparency in appointment of consultants to CCG boards. “I feel one of the obstacles is the conflict of interest rules, which I feel need to be relaxed and replaced by a code of practice similar to that applying to GPs on CCG boards,” he said.

A spokesperson for NHS England said that CCGs must have at least one secondary care specialist and a nurse on the governing body. “NHS England reviewed CCGs’ applications to be established through the authorisation process,” the spokesperson said. “This included a review of each CCG’s constitution and the membership of the governing body. All 211 CCGs should have a secondary care doctor on their governing bodies.”

The BMA is to write to all CCGs for confirmation of which secondary care doctors have been appointed to their boards and how the appointments were made.