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Wednesday 28 September 2016
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CCG 'blocks' ideas fearing 'unpopularity'

A GP surgery in Solihull has accused GPs sitting on its local clinical commissioning group (CCG) of having a conflict of interest as it has blocked six of its 'innovative' cost-reducing ideas.

Christiane Bates, practice manager at the Bernays and Whitehouse Grave Surgery, proposed a number of ideas to Solihull CCG, which centred on offering community-led services focusing on: cellulites, endometrio valori, early pregnancy assessment, ENT microsuction, extended minor surgery, pelvic ultrasounds and an orthopaedic care pathway.
 
However, despite the proposals allegedly reducing costs in moving activity out of secondary care and into the community, they were rejected, as they "didn't quite fall in line with the plan of the CCG".

Bates said the CCG board is now "coming up with its own ideas" and there is "no discussion with the wider practice network".

She accused GPs on the CCG of blocking of her practice's proposals out of fear that their own practices would "fall behind" and become "unpopular" as they wouldn't have the time to implement the new services, thanks to their commissioning workload. 

"The CCG said it is working to a plan, but we don't know what that plan is," she said.

"There is a conflict of interest because the GPs that are sitting in a position of power on the CCG board all work in local practices and wouldn't have the time to implement the changes to GP services of they did authorise their go ahead. Unless you have the resources to accommodate the new services – to employ a session doctor – they will not have time to do it.

"Therefore, they would risk their own practice falling behind and becoming less popular than those who would be able to offer more services. Allowing another practice to offer additional services is a threat to the Board's GPs.

"It is very difficult to be involved in commissioning as a GP because you have got to give up a lot of the work in your practice."

Dr James Kingsland, president of the National Association of Primary Care (NAPC), said he has heard other examples of the same kind of CCG behaviour and urged practices to "hold the CCG board to account" over their decision-making.

"Practices should ask to see the consultation the Board has undergone to assess the decision," he said.

"If we don't have entrepreneurial ideas from practices, we are going to have a one size fits all approach to everything and CCGs will miss the point of their very existence."

More encouragingly, Dr Kingsland himself has received approval from Wirral CCG to extend his practice's services and so is keen to stress there is "good and bad" happening all around the country.

However, Dr Peter Swinyard, chair of the Family Doctor Association (FDA), said he expected Bates' experiences with Solihull CCG "to be the first of many".

Dr Patrick Brooke, accountable officer of Solihull CCG, said the organisation operates a "clear gateway process" for managing business proposals, which includes a detailed 'decision making tree' with "thorough and detailed assessment" of all business proposals, including clinical review by GPs and lay member involvement. 



"We have just received very good feedback on clinician engagement as part of our application for authorisation," he said.



"All our practices are members of locality groups at which such business cases would be discussed with their peers and agreed. We would always encourage our member practices to contact us directly to discuss any concerns they may have further."

Johnny Marshall, interim partnership development director at NHS Clinical Commissioners and advisory member of the NHS Commissioning Board (NHS CB) Authority Future Design Group, admitted that time and resources are a "problem" particularly during the authorisation process.

He said it is not surprising that some people on CCGs may be "overwhelmed" but was optimistic it was something that can be "sorted out in the short term".

Wendy Saviour, director of the NHS CB's Birmingham, Solihull and the Black Country local area team (LAT) said there is no formal process of reporting if CCGs encounter "problems" with their CCGs.

She advised practices to familiarise themselves with the CCGs' plan before submitting ideas and said any complaints can be brought to the LAT if it is a "recurring issue".

A spokesperson for the NHS CB said: "CCGs are membership organisations, made up of the member practices they cover. It is important, therefore, that member practices collaborate and engage with one another to reach decisions that are acceptable to all CCG members.
 

"We would urge practices to use the conflict resolution processes detailed within their CCGs' constitutions if they feel their views have not been fully taken into account."