One year on, new commissioning groups are an improvement on their predecessors but do not reflect the views of members, say GPs

Less than half of GPs feel decisions made by clinical commissioning groups (CCGs), the doctor-led bodies created by the Coalition Government’s NHS reforms to hold local health budgets, reflect their views, shows a survey by the Nuffield Trust and The King’s Fund.

However, the research also suggests that three times as many GPs think they can influence the work of their CCG than could influence their predecessors – primary care trusts.

NHS leaders will be pleased to hear GPs say they increasingly accept the role of clinical commissioning groups in helping to improve general practice Holly Holder, Fellow in Health Policy, Nuffield Trust

The research, published today on the first anniversary of the enactment of the NHS reforms, provides the top-line results from a survey of GPs in six CCG areas. Key findings include:

• GPs have kept up their overall levels of involvement with CCGs compared to a similar survey carried out last year – 71 per cent feel at least somewhat engaged. But the proportion saying they are “highly engaged” fell from 19 per cent to 12 per cent, and GPs without a formal role in the CCG still feel much less engaged with their CCG than those with a formal role;

• Less than four in 10 GPs without a formal role thought decisions made by CCGs reflected the views of their membership, and just one in three felt the new groups were owned by their members. Meanwhile, only a minority of those GPs who did have a formal role thought they had enough support, time, and training to carry out their roles properly;

• An increasing number of GPs agreed that CCGs have a legitimate role to play in influencing their clinical practice including prescribing, referrals and the quality of the care they provide to patients;

• GPs were positive about how CCGs could change and improve general practice itself. Just over half felt that being part of a CCG had already improved their relations with other practices, and had changed the way they referred and prescribed. Although fewer felt that being part of the CCG had improved the overall quality of care they provide;

• Respondents felt CCGs were much more likely to listen to them than the primary care trusts (PCTs) which held the same role before the reforms. 40 per cent said they could influence the work of the CCG, compared with only 13 per cent who had felt the same about PCTs;

• GPs were more likely to rate CCGs as ‘very’ or ‘quite’ influential over their work (73 per cent) than any other body, including NHS England. Meanwhile, just 13 per cent felt that health and wellbeing boards, set up to oversee better joined-up care in the new system, were very or quite influential over their work at this stage.

Holly Holder, Fellow in Health Policy at the Nuffield Trust said:

“NHS leaders will be pleased to hear GPs say they increasingly accept the role of clinical commissioning groups in helping to improve general practice, particularly when it comes to prescribing medicine, referring people to other services and the quality of care they provide to patients.

"The public face of NHS leadership might be Jeremy Hunt – or from today Simon Stevens – but GPs told us that CCGs did more to influence their work.

“Even so, concerns remain about CCGs’ ability to involve local GPs in their work. While overall engagement remains fairly similar to this time last year, only a third of GPs without a formal role reported that the CCG felt like ‘their organisation’ and a similar proportion said CCG decisions simply didn’t their views.

“With NHS England recently announcing plans to commission alongside CCGs, and Labour considering big power shifts to Health and Wellbeing Boards, it is clear that shape and role of commissioning groups will continue to change.

"NHS leaders should pause for thought at the fact that only a minority of CCG leaders told us they felt they had enough support, time and training to carry out the roles they have already been tasked with.”

Ruth Robertson, Fellow in Health Policy at The King’s Fund said:

”It’s encouraging to see that most GPs remain at least somewhat engaged with the work of their CCG – welcome news, given concerns about GP work load pressures and low morale.

"However, there are signs that support from some initial enthusiasts has started to wane, as our data shows a drop in the number of GPs who are highly engaged in the work of the CCG.

"What makes CCGs new and different is the power they give clinicians to decide how local health services are run. Without close engagement from at least a core group of GPs, this key benefit they have over their predecessor PCTs will be lost.

"We will be paying close attention to engagement trends over the next year, as the sustainability of this commissioning model is dependent upon maintaining GP interest and enthusiasm during the tough times ahead.”