GPs must not be left out of clinical commissioning, warns BMA

The emerging clinical commissioning groups (CCGs) must include ordinary GPs in their planning processes, the chairman of the BMA’s General Practitioners Committee has said.

Speaking at the annual conference of local medical committees in Liverpool this week, Laurence Buckman emphasised that CCGs are membership organisations and must seek the views of the GPs in their constituent practices.

“CCGs are our creatures, not just another version of the PCTs [primary care trusts] they replace,” he said. “GPs should be telling them what to do, not the other way round.”

To facilitate GPs’ involvement, local medical committees—the longstanding groups that represent GPs—must work with CCGs and not “withdraw themselves from engagement” on the basis of their opposition to the government’s healthcare reforms, said Buckman. “The General Practitioners Committee has to try to deter the potential for harm within CCGs whilst ensuring that GPs are democratically involved in CCGs, and LMCs [local medical committees] are able to act as the voice of all GPs,” he said. “Ordinary GPs must be there. We must be there.”

The conference passed a motion calling for CCGs to consult with local medical committees on any decision that affects providers of general practice. The motion’s proposer, Andrew Holden, from Hampshire and Isle of Wight Local Medical Committee, pointed out that politicians and organisations seeking the view of GPs tended to turn to bodies such as the National Association of Primary Care when instead they should be talking to local medical committees as GPs’ representative organisations.

Delegates at the conference also discussed how GPs’ impressions of clinical commissioning have changed considerably since the idea was first put forward in a white paper in July 2010. Some argued that the structures that have sprung up as a result of the Health and Social Care Bill threaten the freedom of CCGs.

“It beggar’s belief that the white paper’s caption was ‘liberating the NHS,’” said Chaand Nagpaul, a negotiator for the General Practitioners Committee and a member of the BMA’s council. “For all of us involved in commissioning it feels like commissioning in a straitjacket. This is not the commissioning that we originally supported.” CCGs will need to consult with and make decisions in partnership with their local health and wellbeing board, the new clinical senates, the NHS Commissioning Board, clinical networks, and others, which “is not freedom,” he said.

Motions were also passed calling for CCGs to elect members of their governing bodies through a democratic process endorsed by their local medical committee and for CCGs to have committee observers in attendance at governing body meetings.

A motion calling for every general practice in England to withdraw from involvement in CCGs and to focus on core practice work, which some believe is being threatened by the scale of the changes to the NHS, was rejected by the conference.

Nevertheless, said Buckman, the Health and Social Care Act “risks endangering the NHS in England,” fragmenting care, giving private organisations the chance to “pick off the best bits” of the NHS, and pushing GPs on to less favourable contracts. He warned: “Quality rewards that pay GPs to cut corners on services on cost grounds: coming your way. Micromanagement of GPs’ performance: coming your way.”