The chair of the RCGP has called upon a private law firm to produce some much-needed guidance to support CCGs in coping with disengaged practices.
Speaking at a commissioning roundtable hosted by Management in Practice's sister title GP Business last week (13 March), Dr Clare Gerada said there is a lack of centrally written guidance to advise how CCGs and their participating GP practices alike cope when conflicts arise.
"I haven't seen any guidance outlining what happens when a GP practice chooses not to engage with their CCG because it feels it doesn't agree with the decisions made by the CCG or they are just too busy to attend meetings and fill out forms," she said.
"I would look to Capsticks to help us out here."
Peter Edwards, a Senior Partner at Capsticks law firm, said there are "basic" tools outlined in the government's proposed Health and Social Care Bill, which focus on the "extreme end" of CCG sanctions – including practice expulsion.
Yet, he said there is a lack of centrally-led guidance advising the "many stages" before practice expulsion from a CCG.
Edwards expects the process of engaging disengaged practices will be built around CCG constitutions and inter-practice agreements.
Peer pressure will also play a big part, he said.
"I suspect before expulsion you would move into other areas of performance management," said Edwards.
"If a practice is so disengaged that you would consider expulsion, then they are probably falling down in other areas so the more conventional performance management around the GP contract would come into play.
"Practice expulsion will act as the ultimate sanction – it will be the move that makes the GPs sit up and take notice, because it threatens their business.
"However, as GP practices are effectively the electorate for the leadership of the CCG, expulsion will be rarely used, if ever.
"There needs to be clarity over what levers would be available."
Edwards confirmed Capsticks will be working with CCGs to incorporate tailored sanctioning processes into their constitutions.
Dr Kosta Manis, a commissioning GP from Bexley CCG, said CCGs need to spend their time looking inwards to find out the reasons why practices are disengaged rather than focusing on the development of guidance to offer sanction choices.
"CCGs will be built from each and every member practice - to harness the insights from their day-to-day contact with patients, to ensure that commissioning decisions respond to patient needs and deliver continuous quality improvement," said a spokesperson from the NHS Commissioning Board.
"Every GP practice will be a member of a CCG, to make sure all patients' needs are met and all views are heard.
"Our early learning is already showing that this approach is increasingly enabling practices to engage."
By Louise Naughton