Intended for healthcare professionals


General practices should beware CCG constitutions with performance management clauses, says BMA

BMJ 2012; 344 doi: (Published 19 June 2012) Cite this as: BMJ 2012;344:e4210
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}

General practices should not sign up to constitutions that allow clinical commissioning groups (CCGs) to manage the performance of member practices, the BMA’s General Practitioners Committee has warned.

The committee has received reports of constitutions having inappropriate clauses with respect to performance management and of CCGs acting beyond the provisions in the Health and Social Care Act.

The committee added that CCG constitutions should concern how CCGs work, and not how member practices work, and should focus primarily on CCG structure and governance.

GPs who are under pressure to sign constitutions with inappropriate clauses should consider withdrawing their support for the CCG, advised Laurence Buckman, the committee’s chairman.

“Some GPs are understandably scared about the willingness of some CCGs to engage in these kind of threats and counterthreats, and it’s not productive, it’s not helpful,” he said. “If [CCGs] continue to threaten their members, then it seems to me that members should ask themselves why they are supporting this particular organisation.”

The General Practitioners Committee will shortly be issuing new guidance to practices on CCG constitutions and a checklist that practices can use to inspect whether key elements are included in a constitution before they sign it.

The committee also reiterated its advice that CCG constitutions should involve local medical committees, a point echoed by Barbara Hakin, national director for commissioning development at the NHS Commissioning Board, in the board’s latest bulletin for proposed CCGs (

In it she wrote, “I recognise that a good relationship between CCGs and local medical committees is critical, and we would encourage you to build this into your approach.” She added that it would also be helpful for at least one member of each practice to understand the full constitution.

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