Agenda item

Clinical Commissioning Group (CCG) GP Member Practices - Option to Move to Delegated Commissioning Arrangement

North West London (NWL) CCGs are now consulting member practices on the option of a move to ‘level 3 - fully delegated’ commissioning arrangements from 1st April 2017. CCGs that move to fully delegated arrangements will be responsible for functions previously carried out by NHSE and their own statutory duties. The Health and Wellbeing Board is asked to note that Brent CCG Member Practices will take a vote on the option of moving to level 3 – delegated commissioning arrangements from 1st April 2017.


Sarah McDonnell (Assistant Director of Primary Care, NHS Brent CCG) introduced the report, which provided the Board with an overview of the ongoing consultation between NWL CCGs and GP Member Practices on expanding the scope of CCG commissioning arrangements. She explained that GP Member Practices had moved to Level 2, joint commissioning arrangements, in recent years and had now been asked to vote on whether to move to Level 3, delegated commissioning arrangements. The vote was specified to take place between 30 January and 13 February, with the result announced to be on 17 February 2017. 


The Board heard that if the GP Member Practices voted in favour of a move to delegated commissioning arrangements, this would mean that CCGs would be newly responsible for functions previously carried out by NHS England (NHSE) and therefore would take on the accompanying statutory duties. Ms McDonnell ran through the separation of functions between the CCG and NHSE, which would take place (specified in paragraph 1.2 of the report) and noted that around half the CCGs in England had already taken up Level 3 commissioning and that NWL CCGs had begun a process of due diligence to plan accordingly, centred on three specific workstreams (governance; workforce; finance and legal) should the Member practices vote in favour. Ms McDonnell explained the benefits and risks to the move, which had been considered (outlined in paragraphs 3.9 and 3.10 of the report) and noted that a key risk identified was the CCG’s capacity in terms of staff and resources, and that a transition plan would have to be drawn up to accommodate this.


Members of the Board discussed the potential problem of a lack of capacity at NWL CCGs to be able to enable this change and whether there had been any additional resources earmarked to address this in the near future. Sarah Mansuralli (Chief Operating Officer, NHS Brent CCG) responded that it was unlikely that there would be any additional resources specifically for NWL CCGs and that this problem would still be prominent in 2018/19 which informed the need for a transitional plan.


There were additional questions arising on whether Brent CCG would be championing the Level 3 arrangements if the capacity issues were not as prevalent and whether it was felt likely that the Members Practices would vote in favour of delegating commissioning at this stage. Both Sarah McDonnell and Rob Larkman (Chief Officer, Brent, Harrow and Hillingdon Clinical Commissioning Groups) emphasised that it was incumbent on the CCG  to remain impartial and merely lay out the benefits and risks clearly, allowing Members to vote without a steer one way or the other. Sarah Mansuralli added that it was also essential that the CCG retained its good relationship with GP practices and managed the results regardless of which way the vote went.


It was thought that NHSE’s expectation had been that all CCGs would implement delegated commissioning functions within the next few years. It was questioned whether this would be a future source of frustration for Members Practices if they chose to vote against a proposal on Level 3 delegated commissioning for it to be implemented at a later stage regardless. Sarah Mansuralli acknowledged this point and stated that the CCG was supportive of Members Practices taking a view on this. She stated that either way it would manage and act accordingly to ensure there were no adverse effects on the relationship between the CCG and Members Practices.


RESOLVED that the upcoming consultation of GP Member Practices on whether to move to level 3 delegated commissioning arrangements from 1 April 2017 be noted.

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