Family doctors in Brighton and Hove have been given permission to take key decisions about their own pay and performance, it was announced this afternoon (Tuesday 24 January).
They will have a range of other rights and responsibilities under the arrangement known as co-commissioning, members of the Brighton and Hove Clinical Commissioning Group (CCG) were told.
Fears have been raised about potential and perceived conflicts of interest by local doctors as well as key health organisations such as the King’s Fund.
Questions around possible conflicts of interest were among the reasons local doctors were initially reluctant to take on the extra responsibilities. But last year they voted to take the plunge.
A similar arrangement, known as GP fundholding, was introduced in the 1991. It was abolished less than seven years later after a series of criticisms, including by the Audi Commission, an official spending watchdog.
King’s Fund policy fellow Ruth Robertson has written about the latest trend of giving delegated commissioning powers to family doctors.
She wrote: “These new responsibilities shine a light once again on an issue that has plagued CCGs since their inception – the conflict of interest faced by GPs who are buying services from themselves and potentially managing their own contracts.
“CCGs looking to take on greater responsibility for commissioning primary care services would be wise to look back on the experience of GP fundholding.
“That experiment in GP-led commissioning in the 1990s was undermined at least partly by public outrage at claims of GPs lining their own pockets.
“CCGs must demonstrate that they have clear robust governance processes in place that show NHS spending decisions have not been influenced by vested interests, to avoid challenges from providers and the public.”
Brighton and Hove CCG has already set up a Primary Care Commissioning Committee with independent and lay members and a representative of local watchdog Healthwatch Brighton and Hove.
The decision announced this afternoon means that, from Saturday 1 April, NHS England will hand over to Brighton and Hove CCG
• the management of general practice contracts – including monitoring the performance of local GP practices and taking actions such as issuing improvement notices and removing a contract
• approval of practice mergers or changes to individual GP practice boundaries
• making decisions on payments and schemes that affect local GPs
• making decisions on issues related to GP practice premises
The CCG said: “It is widely recognised across the NHS that involving CCGs more in the commissioning of general practice provides an opportunity for offering better more joined-up care for patients and local populations.”
The CCG also promised greater investment in general practices locally in the coming financial year 2017-18 – and the one after – as part of a five-year plan.
• £900,000 will be invested in transformational support. This investment will be utilised for implementation of “10 high-impact actions” and ensuring future sustainability in line with national guidance
• £90,000 will be allocated for expenditure on online general practice consultation software
• £60,000 will be assigned to the training of care navigators and medical assistants for all practices within the city
• £1.8 million funding will be used to improve access to general practice
The CCG added that it had organised local GP surgeries in Brighton and Hove into six clusters looking after 30,000 to 50,000 patients each.
And it planned to form “multispecialty community providers” (MCPs) by 2020 to break down the barriers between primary care, community care, mental health care and adult social care.
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