What is happening?
All clinical commissioning groups (CCGs) were working towards becoming NHS statutory bodies for 1 April 2013. To achieve this they had to successfully complete an authorisation process.
In order to be authorised, a CCG is required to have a constitution outlining a robust governance structure, with the support of member practices. The constitution will define the governance and operating policies of the CCG and will impact on the relationship between practices and the CCG.
What the BMA thinks
The BMA believes the relationship between CCG and practice should be characterised by genuine engagement. A good constitution will be vital if practices are to be able to hold their CCG to account for the decisions made on their behalf.
The BMA is concerned that the engagement of practices by CCGs varies hugely from area and to area. It is important that NHS England asks CCGs to clearly show that they have the support of member practices as part of the authorisation process.
If a practice is concerned about how the CCG has involved them, they should ask their Local Medical Committee (LMC) to raise this with the CCG or NHS England local area team.
A good constitution should:
- Be confined to governance and operational remit
- Be a clear and concise summary of key points for practices
- Ensure all practices are represented in the process by defining the involvement of the LMC
- Clearly outline the dispute process by which practices can raise grievances with their CCG.
A good constitution should not include:
- Clauses relating to contractual responsibilities of practices
- Clauses to 'expel' practices on the grounds of 'poor performance' or for failing to follow CCG policies
- Clauses relating to the performance management of practices for example in relation to budgetary constraints, prescribing, referrals or emergency admissions
- Any 'obligation' on practices to undertake work for the CCG, which should be voluntary and resourced appropriately
- Details of any incentive schemes rewarding practices for remaining within budget or achieving financial savings
- Clauses to monitor areas covered by the GP contract
What you need to know
It is essential that every practice understands the components of the CCG constitution. The BMA urges all practices to reassure themselves of the appropriateness and content of their proposed CCG constitution, to seek advice from their Local Medical Committee (LMC) and the BMA General Practitioners Committee (GPC).
CCGs are membership organisations and CCGs have no right to compel practices to sign constitution they are not content with. A practice has the right to refuse to sign these documents until their concerns have been addressed by the CCG.
Although it may be impractical for every GP in a practice to have read the CCG constitution in detail, it is essential that every practice understands what the constitution contains, and to propose amendments as appropriate.
This can be facilitated by:
- A short and focused constitution, written in plain English, and confined to a governance and operational remit
- A clear and concise summary of key points for practices
- Involvement of the LMC in developing the constitution, to ensure practices are represented in the process and to reassure member practices
CCG constitutions may presently be in draft form and are likely to develop further over time. It is important that there is provision for practices to approve any modifications or additions to the constitution as they arise, to ensure that the constitution has the continuing support of constituent practices.
All GPs (regardless of contractual status) should have the opportunity to stand for all elected positions (at board level or below) and vote in elections.
The constitution of the CCG should explicitly state this and outline electoral processes inclusive of all GPs in the CCG area.