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Practice expulsion from CCGs ‘should be an option’

Practice expulsion from CCGs ‘should be an option’

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CCGs should be allowed to exclude “dysfunctional” practices that pose a threat to the local health economy.

DH advisor and President of the National Association of Primary Care (NAPC) Dr James Kingsland said providing the CCG has carried out a “justifiable process over two or three years”, then the exclusion of dysfunctional practices that pose a risk to the local health economy from a CCG “would be an option”.

“I would like to think [exclusion] would be rare and most problems would be resolved before it got to such a point,” he said.

There will become a point whereby the NHS Commissioning Board (NHS CB) would need to get involved in the performance management of practices but Dr Kingsland said this should be on a CCG’s terms.

“CCGs should be able to go to the board and seek advice [on performance management] but not be forced into a decision either way,” he said.

“I would imagine the board would want to carry out a review if a CCG expressed a desire to exclude a practice.”

Dr Richard Vautrey, Deputy Chair of the British Medical Association’s GP Committee, said the idea of a practice’s exclusion from a CCG is “nonsensical”.

“The CCG’s role is to engage and encourage development among practices; it isn’t to use punitive mechanisms and to be obsessing about poor performance,” he said.

“This is an example of people dwelling on the Andrew Lansley vision in which CCGs were initially described as clubs which practices could join or leave depending on your philosophy.

“We have moved away from that now to a model that is more akin to that of PCTs, where your membership is defined by geography.

“It is in no-one’s interest to fail to support a poor-performing practice whatever the situation.”

Ultimately, if the reforms are going to work, Dr Kingsland said some GP practices will find themselves going through a restructuring process over the next decade.

“It is very unlikely every single practice will be structured in the same way in ten years, I can’t imagine the NHS CB wouldn’t want that to change if the reforms are to be successful.”

A spokesperson from the NHS CB said CCGs will have a role in assisting the board in “holding practices to account for the quality of services they provide under the GP contract”.

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