Every CCG is required by law to have a constitution. The constitution is a legal document that should outline the governance structures and responsibilities of the CCG.
Why the constitution is important
- A CCG must ensure that its constitution outlines how it will discharge its functions, elect subcommittees and make decisions.
- Practices can challenge a CCG if they feel that the CCG is not fulfilling its statutory duty to ensure effective member participation.
- The constitution should include electoral procedures and how member practices can remove a CCG board.
- Practices should ensure they understand how they can hold their CCG to account and get involved in the decisions of the CCG.
Responsibilities of practices
The constitution may also include responsibilities of practices as members of the CCG, for example, the meetings that practice representatives are expected to attend.
It is important that practices understand these responsibilities. It is also important that practices ensure that these responsibilities are reasonable and within the remit of the CCG. For example, the constitution should not require practices to undertake any unresourced activity for the CCG.
The constitution should not contain any clause relating to contractual responsibilities of GP practices in respect of core contracts.
Legal requirements of practices
- Practices must nominate a practice representative to liaise with the CCG.
- Practices should be able to demonstrate that they have engaged with the CCG in line with the CCG constitution and reasonableness of the CCG's requests.
- Practices should abide by the CCG constitution.
- Practices should work with commissioning decisions of the CCG and NHS England.
Disagreements with the CCG
Practices must raise issues through the appropriate channel with the CCG and not, for example, simply refuse to cooperate. Channels to deal with disagreements should be outlined in the constitution.
For instance, your primary duty is always to the care of the patient and you should ensure that you are satisfied that you are fulfilling this duty.
If you are concerned that a clause in the CCG constitution or the CCG's commissioning decisions conflicts with your GMC duties, you should raise these concerns with the LMC and the CCG.
What the constitution should contain
The constitution should include the detailed arrangements under which the CCG is to be directed and controlled. It should include a clear definition of the responsibilities and duties of the executive team of the CCG (including the accountable officer, the chair and the chief financial officer).
The views of practices in the CCG need to be represented as part of the decision making process of the CCG. Practices need to ensure that the structures of the CCG, including democratic processes, accurately reflect the views of CCG members.
In order to avoid potentially costly and distracting future legal claims, it is recommended that constitutions are drafted to include a dispute resolution procedure. Appropriate legal advice (which for members could be obtained at a discounted rate from BMA Law) should be taken on any such agreement.
The constitution should provide which specific responsibilities can be delegated by the CCG to particular GP practices with lead responsibilities.
To remove some or all of the CCG board where necessary and appropriate.
There should also be a process for making amendments to the CCG constitution.
What the constitution should not contain
- Any clause or requirement relating to contractual responsibilities of GP practices in respect of core contracts.
- Unreasonable requirements placed on GP practices, including unresourced work for the CCG.
- Any sanctions relating to performance management by CCGs of GP practices in respect of core contracts.
- Clauses relating to expulsion of GP practices from the CCG. The CCG has no such power.
Changing the constitution
The CCG will need to submit any changes to NHS England for approval.
The CCG will need to outline the changes and the reasons why they wish to make the change.
The CCG will need to provide assurance that the change has been agreed with member practices and that appropriate legal advice has been sought.
There are two deadlines for applications to change the constitution each year - 1 June and 1 November.
If the CCG refuses to change the constitution
If your CCG is not listening to the concerns of member practices, you should involve your LMC at the earliest possible point.
Practices, via the LMC, should escalate the issue to NHS England if the CCG is refusing to consider any proposed changes or has not given practices the opportunity to input into decisions about the constitution.