Exclusive GP commissioning leaders are set to snub GPC and RCGP advice to merge to cover at least a million patients, amid claims that the two organisations have ‘lost the plot' in calling for a wholesale restructure of clinical commissioning groups.
The move, prompted by the announcement of a modest £25 per head in management costs for CCGs, marked a shift in policy from the GPC, which had previously warned that CCGs below 500,000 would struggle to control costs.
But CCG leaders told Pulse they did not plan to follow the advice, claiming such moves would destroy localised commissioning, disengage GPs and not prove cost effective.
It came as the Clinical Commissioning Coalition of the NHS Alliance and NAPC urged that CCG configuration should not be imposed on the back of speculation around management allowance.
Of eight CCG leaders contacted by Pulse, none plan to follow the BMA and RCGP advice to cover a million or more patients.
Five said they had no current plans to merge at all, while three have already merged or plan to merge to cover up to 300,000 patients – to give themselves a better chance of being authorised - but do not plan to merge again.
Dr Stewart Findlay, a GP in Bishop Auckland and chair of Durham Dales CCG, said his group had already been merged to cover 280,000 patients, but ruled out any further changes, which he said would merely re-create PCTs.
He said: ‘I think they've completely lost the plot. We know large PCTs didn't work, if we make them even larger, what evidence is there they will be made even better?'
'There will be much more central control and it will result in a less cost-effective NHS. If we can simplify and allow clinicians to get on and do things, I don't think we need the same level of resource we had in the past.'
Dr Findlay warned: ‘We have merged into a larger CCG now covering 280,000. Even that is too big to engage local GPs. Our aim is to have localities with as much autonomy as possible.'
‘The more remote the statutory body, the more disengaged GPs and patients will be. If everything is in the centre, those that are keen will walk away and do something else. There will be complete disengagement, no innovation, nothing but bureaucracy and we'll be in an overspend scenario.'
Dr Steve Kell, a GP in Worksop, Nottinghamshire and chair of Bassetlaw CCG, said his group, which covers just 110,000 patients, accepted the need to work collaboratively but did not plan to formally merge, and wanted to become a statutory body in its own right.'
Dr Kell said: ‘The smaller you are, the more you will have to work in partnership with others and with neighbouring CCGs to share managerial capacity. We'll have to work with others on developing a commissioning support model.'
‘But I still think it's feasible to have CCGs the size of Bassetlaw. We cover 110,000. We aim to be authorised next year and remain as an organisation within Bassetlaw.'
Dr Baz Barhey, a GP in Luton and chair of the Luton CCG, said his group, which covers 270,000 patients, had ‘no plans to merge at the moment'. ‘We are waiting to see further guidance. [Merging further] will take the localism away from it,' he said.
Dr Michael Dixon, chair of NHS Alliance, said: ‘It is absolutely fundamental that CCGs are free to make their own decisions. It is not up to any particular organisation to dictate what CCGs should look like and the coalition is totally committed to supporting CCGs' independence and helping their leaders to work through any challenges that may arise.'