Just what the Doctor ordered? The ‘added value’ GPs bring to clinical commissioning

BY NEIL PERKINS

Our new journal paper published by the British Journal of General Practice looks at what ‘added value’ GPs think they bring now they are responsible for commissioning healthcare in their local communities.  A key assumption underpinning CCGs is that GPs ‘add value’ to commissioning centred on their intimate knowledge of their patients.

The coalition government’s 2012 Health and Social Care Act abolished Primary Care Trusts (PCTs) and Strategic Health Authorities in England, replacing them with Clinical Commissioning groups (CCGs).These are clinically led organisations which became responsible for the care of the population within their geographic boundaries on April 1st 2013. CCGs are now responsible for 65% of the overall NHS budget, commissioning routine and emergency care. Another new body – NHS England (NHSE) – oversees CCGs and is responsible for commissioning services such as primary care and specialised services at a national level. At the heart of the new arrangements is the desire by government to increase competition, reduce bureaucracy and most importantly, a desire to increase clinical leadership in the NHS.

Our interviews with clinicians and managers revealed a range of claims concerning GP added value:  they centred on their proximity to patients and on the value of their clinical knowledge.  Firstly,GPs are in the position of knowing patients’ real experiences of all aspects of the services provided by the NHS. Furthermore, GPs can quickly see any common factors from patients’ feedback such as the lack of service provision in any areas. GPs also understand patients’ needs and wants and what services and support they require and when. As such, they can understand where service provision needs to be enhanced or altered to better reflect patients’ needs.

Secondly, clinical knowledge and input were seen as critical, not so much in the detail about particular treatments, but in the way that the greater involvement of people with clinical knowledge changed the focus of discussions. In the PCT, there may have been more of a focus on such things as finance and costing by managers, and not whether a service is performing to expectations or the clinical value of the service. It was claimed that the emphasis now has now shifted to a more clinical focus with GPs in the CCG.

Implications for research and practice

Our paper reports opinions and it is clear that those closely involved in CCGs are convinced of the value of what they do. The crucial question now is the way in which these beliefs, aims and aspirations play out in practice. Clinicians have been involved in commissioning before: do the new structures better enable the effective wielding of GPs’ knowledge in the commissioning process? Focusing upon the knowledge that individuals bring raises questions about whose voices are heard. Our respondents were largely drawn from the ranks of senior clinicians; if these are the only voices heard then there is danger that wider evidence will be ignored. CCGs will need to find ways of bringing in other voices, including their own rank and file as well as public health and others.   Finally, research needs to explore in more detail the extent to which GP voices are needed in the day to day running of the CCG and on what they are needed for. Our respondents spoke feelingly of the workload they faced. It is clearly unsustainable to have GPs everywhere and present on every occasion, and what might be called the ‘smart use’ of GP knowledge must be the aim.

Neil Perkins is a Research Associate in the HIPPO team (Health policy, politics and organisation group), part of the Centre for Primary Care in the Institute for Population Health at the University of Manchester

Disclaimer: The research for this paper is funded by the Department of Health. The views expressed are those of the researchers and not necessarily those of the Department of Health.

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