This guidance details the important implications of Clinical Commissioning Group (CCG) constitutions for GPs and practices and provides practical advice within these Frequently Asked Questions (FAQs).
If you have any questions about your CCG constitution you should contact your LMC or the BMA by emailing [email protected]
|FAQs on this page include:
- What is your CCG constitution?
- Why is my CCG constitution important?
- What does being a member of a CCG mean for my practice?
- What should the CCG constitution contain?
- What should the CCG constitution NOT contain?
- How was my CCG constitution drafted?
- What can I do to protect my practice?
- What if I am not happy with something in my CCG constitution?
- How can CCG constitutions be changed?
- What if my CCG refuses to consider changes to the constitution?
- Can the CCG expel my practice from the CCG?
- What if I am concerned that the CCG constitution conflicts with my GMC duties?
- I am a sessional GP - do I need to read the CCG constitution?
What is your CCG constitution?
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 is my CCG constitution important?
All GP practices are required by law to be a member of a CCG. Changes to the GMS contract regulations in 2013 made it a contractual requirement for all GP practices to be a member of a CCG and also for every GP practice to nominate a practice representative to liaise with the CCG. CCGs are statutory bodies and the CCG constitution is a legal document that practices, as members of CCGs, should ensure they have read and understood.
CCGs are membership organisations, accountable to member practices. A CCG must ensure that its constitution outlines how it will discharge its functions, elect subcommittees and make decisions. Importantly, CCGs have a statutory duty to ensure that these processes all ensure the effective participation of member practices in the exercise of the CCG's functions as outlined in the CCG constitution (Health and Social Care Act, Schedule 2, paragraph 6). This means that practices can challenge a CCG if they feel that the CCG is not fulfilling its statutory duty to ensure effective member participation. For example, 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.
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 also not contain any clause or requirement relating to contractual responsibilities of GP practices in respect of core contracts.
Read GPC guidance on the content of the CCG constitution
What does being a member of a CCG mean for my practice?
The legal requirement for a GP practice to be a 'member' of a CCG means:
- that practices must nominate a practice representative to liaise with the CCG;
- that practices should be able to demonstrate that they have engaged with the CCG in line with the requirements outlined in the CCG constitution and subject to the reasonableness of the CCG's requests;
- that practices should abide by the contents of the CCG constitution (this does not include clauses that are outwith the statutory remit of the CCG, for example, clauses relating to the 'expulsion' of a practice from the CCG);
- that, similar to the requirements for practices to work with commissioning decisions of PCTs, practices should work with commissioning decisions of the CCG and NHS England.
None of this precludes a practice having a disagreement with the CCG about a commissioning decision or clause in the constitution - CCGs are membership organisations and must operate democratically. However, practices must raise these issues through the appropriate channel with the CCG and not, for example, simply disengage and refuse to cooperate. The appropriate channels to deal with disagreements should be outlined in the constitution and governance arrangements of the CCG.
For instance, your primary duty is always to the care of the patient and you should ensure that at all times 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, then you should raise these concerns with the LMC and the CCG.
What should the CCG constitution contain?
The GPC's guidance on constitutions provides details of the information that GP practices should expect to be included in the CCG's constitution.
It is important to ensure that the constitution sets out a number of key principles, which include but are not limited to:
- Effective corporate governance:
the constitution should include the detailed arrangements under which the CCG is to be directed and controlled and 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);
- Effective decision-making:
the views of practices in the CCG need to be appropriately represented as part of the decision making process of the CCG. Practices need to ensure that the representative structures of the CCG, including democratic processes, accurately reflect the views of CCG members;
- Effective dispute resolution:
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 the contents of any such agreement.
- Effective powers of delegation:
the constitution should provide detailed powers of delegation under which (where appropriate) specific responsibilities can be delegated by the CCG to particular GP practices with lead responsibilities; and
- Power to demand a vote of no confidence within the CCG:
i.e. to remove some or all of the CCG board where necessary and appropriate.
- Process for making amendments to the CCG constitution.
- The BMA strongly recommends that CCG constitutions should include a formal commitment to engage with the LMC, as the statutory representatives of the local profession.
What should the CCG constitution NOT contain?
The CCG 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.
How was my CCG constitution drafted?
CCGs had autonomy to draft their own constitutions and so CCG constitutions vary hugely from area to area. The Department of Health did publish a model CCG constitution that some CCGs may have used or modified. Your CCG should have asked for input from member practices in drafting of the constitution, although levels of GP practice involvement also varied significantly from area to area.
As part of the authorisation process, NHS England will have approved your CCG constitution. NHS England will also have asked your CCG to demonstrate that the constitution has the support of member GP practices. In some areas, CCGs asked all practices to sign a copy of the CCG constitution. In other areas, CCGs will have asked practices simply to put on record their support for the constitution.
What can I do to protect my practice?
You should ensure you have read and understood your constitution. You should ensure you understand all the clauses and seek clarification about any clause you do not understand. You should challenge any clauses in your constitution you are not happy with and seek to amend the constitution (see below).
What if I am not happy with something in my CCG constitution?
CCGs are membership organisations, accountable to their member GP practices. If you are not happy with something in your CCG constitution you should raise this with the CCG, other member practices and the LMC. It is important that there are processes in place for practices and CCGs to agree changes to the constitution as CCGs will need to evolve and adapt as they develop as commissioning organisations.
If there is a clause in your constitution that you do not understand or that you are not happy with, you should:
- Ask for written confirmation from the CCG as to the meaning and the purpose of a clause;
- Record your concerns in writing to the CCG, outlining the reasons for your objections;
- Seek the views of other member practices and the LMC. If necessary, ask the LMC to seek advice from the GPC.
It is important that the constitution outlines a procedure for requesting changes to the constitution and a process by which member practices can agree a change. Once a change has been agreed between member practices and the CCG, the CCG will need to notify NHS England that they wish to change their constitution.
How can CCG constitutions be changed?
If a CCG wants to make any changes to the constitution they submitted to NHS England during the authorisation process, they will need to submit these changes to NHS England for approval.
In making the application to change the constitution, 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.
In considering applications, NHS England will take into account a range of factors, including whether the CCG has consulted relevant stakeholders. Ordinarily, NHS England will make a decision within 8 weeks of receiving the application. However, in some circumstances, for example where the change has implications of the allotments to CCGs, NHS England may choose to delay the decision until later in the financial year. There is no appeals process once a decision has been made.
What if my CCG refuses to consider changes to 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 democratically input into decisions about the constitution. In notifying NHS England, practices and the LMC should clearly outline the onerous clause and the reasons why a change is requested. You can also raise any concerns you have with the GPC office by emailing [email protected]
Remember that CCGs are membership organisations and are accountable to member GP practices. If the CCG governing board refuses to consider the democratic wish of member practices, the membership can propose a vote of no-confidence to seek to replace the board. This is why it is important that the constitution contains clauses outlining how GP practices can hold the board of the CCG to account.
Can the CCG expel my practice from the CCG?
The CCG cannot expel a practice as they need to have coherent geographical coverage. There should be no provisions within the constitution that give CCGs the power to expel a practice, as this is not within the power of the CCG.
What if I am concerned that the CCG constitution conflicts with my GMC duties?
Your primary duty is always to the care of the patient. If you are concerned that clauses in your CCG constitution conflict with your duty as a doctor you should raise your concerns with your LMC and make the CCG aware. You should then follow the process outlined in your CCG for requesting changes to the CCG constitution.
Read GPC guidance on conflicts of interest
I am a sessional GP - do I need to read the CCG constitution?
Yes. Although the Health and Social Care Act states that the members of CCGs are GP practices, many good CCGs have made arrangements for sessional GPs to be involved in their CCG.
The GPC has strongly recommended that CCGs should ensure that all GPs, regardless of contractual status, are able to stand and vote in CCG elections. Sessional GPs have an important contribution to the clinical commissioning process and may have more flexibility to take on commissioning roles in their CCG.
Similarly, the GPC has encouraged all practices to keep sessional GPs who work in their practice up to date with communications from the CCG so that sessional GPs can get involved if they wish to.