Over the Christmas period it was announced that a further 50 or so CCGs have been authorised to take on delegated responsibility for commissioning GP services from April. They join the 65 CCGs who did so in April 2015 and, subject to the completion of paperwork, it means over half of all CCGs will be commissioning the majority of GP services in 2016/17.

Most involved in primary care will have their own view on whether this is a good thing for general practice or not, but what does it actually mean for general practice? What has been achieved since April 2015 when the first tranche of CCGs took on greater responsibility for commissioning GP services?

Evolution not revolution

A quick ring round of practices in the ‘new-style’ areas revealed that change has been extremely limited. Comments suggest that, in most cases, it might still be too early for any meaningful changes to have been made. A couple of practice managers told us that they’ve noticed no changes at all, while others have suggested that there has been talk of changes and plenty of local consultation but no real action.

However, a few CCGs have rolled out some changes (or are planning to), including:

1. The dropping of QOF: NHS Somerset dropped the QOF and replaced it with a new quality improvement scheme that better addressed needs of practices in its area. An independent evaluation of its first year recently concluded that it had been beneficial for both GPs and patients, finding that dropping the QOF has freed up GPs to offer patients more holistic, person-centred and co-ordinated care – without any reduction in measures of quality.

Practice managers reported that admin was much more straightforward too as they were allowed to drop reporting of all but a few ‘core clinical’ QOF indicators. In exchange, they provided reports on how the funding has been used to improve local services through integration of general practice with urgent care services, offering more personalised care and building practice sustainability.

2. Revised local funding models: NHS Warrington CCG is proposing to increase average funding for GMS practices by £200,000 under a local contract, which will see GPs providing extra services in clusters. The CCG is proposing to pay GP practices baseline funding of £90 per patient – almost £17 more per patient than the current national global sum payment of £73.56 – which has become possible due to its co-commissioning status. Under the proposals, practices would work in clusters covering more than 30,000 patients, as stipulated in the new contract announced by the Prime Minister last year.

Some of the extra money will come from redistributing PMS funding and some as a result of national redistribution of MPIG, as the CCG has hardly any MPIG practices but historically high PMS funding. However, the CCG has admitted that PMS practices will lose out under the new model, as it is using the PMS ‘premiums’ to fund the new contract model.

Emphasis on local primary care

In addition to the above, other initiatives being rolled out include £95-per-patient guarantees to practices reducing emergency admissions, a £1m per annum investment in GP commissioning staff and the delaying of clawbacks of funding from PMS practices.

CCGs that are already commissioning services have made it clear that PMs can expect CCGs to put more emphasis on primary care in order to reduce hospital admissions. Much more ‘local thinking’ can be expected. One CCG suggested that practice managers should prepare for:

• The roll-out of more local incentive schemes that are aligned with a CCG’s strategic intentions, such as reducing A&E admissions.
• Plenty of consultation with patients in order to define the way forward.
• Commissioning based on the best outcomes for patients in that area following more consultation with primary care providers of all types – and the questioning that this will entail.
• Improved arrangements for GP practices to work together on areas such as longer opening hours, specialist service provision and changes to the organisation of community based services.
• Co-commissioning primary care is an opportunity for GPs to be paid for work that can be better done out of hospital so this is likely to happen – practices are encouraged to think of ways in which they can achieve this.

While, in theory anyway, this might make sense, there’s a danger that it could create confusion amongst practices so it pays to keep a close eye on what your local CCG is up to, if they are to take on greater commissioning responsibilities. A full list of participating CCGs can be found here.

As has been said before, this roll-out could be a sign that NHS England does not have the capacity to commission primary care well. Now is the time for CCGs and their local flexibilities to reward practices taking on work from secondary care and effectively manage primary care on a more flexible, local basis.

What do you think of CCGs taking on more commissioning of primary care? Have you had any experience of it, positive or negative? We would love to hear from you, either via the option to comment below or in the forum here.

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