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CCG Series: On the fear of conflict of interest

CCG Series: On the fear of conflict of interest
27 September 2013

Joining the call for CCGs to commission primary care is Dr Carl Ellson, South Worcestershire CCG's clinical chair, exclusively for The Commissioning Review

Joining the call for CCGs to commission primary care is Dr Carl Ellson, South Worcestershire CCG's clinical chair, exclusively for The Commissioning Review
Events on the ground are fast overtaking any national or local primary care strategy right now and I predict that by the time many of you have read this there will have been more mixed messages on why primary care needs to transform – how on the one hand GPs are ‘failing the NHS’ and as a result A&E departments can’t cope and on the other, how the future of the NHS needs to build on the strengths and successes of primary care.
So what role does a clinical commissioning group (CCG) play in supporting its member practices through this ‘year of challenge’ and those ahead? We all know what these challenges are – the ageing population, increasing number of patients with a plurality of long term conditions, the need to be a generalist and a specialist; a bigger and different model of general practice while retaining that critical relationship with patients which keeps many of them out of hospital and cared for at home. All of this being played out at a time of diminishing funding. 
Then there are the PMS reviews, which raise the question – could they have an impact on quality of care? I know that many GMS practices see a move towards equalisation as divine retribution, and the only buffer they may have against further reductions in income; assuming that the money is re-invested back into primary care. 
CCGs have no voice in how this policy will be operationalised locally. This responsibility is with NHS England, through its area teams. Yet CCGs have a shared statutory responsibility to improve the quality of primary care.
We are committed in my CCG to ensuring that our practices provide a consistently high standard of care. Unwarranted variation is explored and reduced and we provide support, development, and education to make sure that continuous improvement is on everyone’s agenda. Does the commissioning of primary care (i.e. holding the contract) by any organisation other than a CCG with its in-built expertise make sense or help deliver the transformation that is needed? I think not. At best the symbiotic relationship which a CCG has with its member practices must be replicated in how NHS England undertakes its role – if this is to continue. 
A recent report, drawn up jointly by the Nuffield Trust and King’s Fund, highlighted “the need for further clarification by NHS England as to the precise nature of CCGs involvement in developing, commissioning and assuring the quality of primary care (over and above core general and primary medical services) and other care providers”. It also suggests that “an alternative or intermediate approach to a new contract for primary care is for CCGs be given a mandate to commission additional services from general practice”. (Securing the Future of General Practice, King's Fund and the Nuffield Trust,  July 2013).
This is the conversation and discussion we need to start having – and soon. New GP contracts are more infrequent than a solar eclipse. My hope is the new contract is flexible enough to enable us to develop the new models of primary care that we know general practice can deliver and that the CCG is the organisation offering it.
In an ideal world CCGs would be given the autonomy to commission primary care directly – but I realise this is fraught with complications such as conflicts of interest. Maybe the best compromise would be that NHS England commission core primary care through the new contract but that CCGs are allowed the flexibility to commission enhanced primary care services – ‘primary care plus’ – which best fit with the needs of their local population. A win-win situation if you like.
Either way we must not let the fear of conflict of interest stand in our way…

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