Commissioning England Wales

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Commissioning guide for LMCs

The key role of Local Medical Committees

As the only statutory representatives of GPs and practices, LMCs continue to have a key role in engaging with the new commissioning structures in their area, representing GP practices and keeping up to date on local developments.

NHS England has publically acknowledged this role and has committed to engaging with LMCs.

To remain effective as representatives of the profession, LMCs need to develop good working relationships with the new bodies to make sure their views are represented.


The Health and Social Care Act requires all GP practices to belong to a CCG. Where a practice has not signed up to a CCG, NHS England will allocate a practice to the most appropriate CCG.

The contract negotiations for 2013-2014 will include negotiation of the change in wording of the contract to refer to membership of CCGs.


The relationship between practices and CCGs

LMCs should be emphasising to practices that membership of a CCG does not give a CCG the authority to dictate performance requirements or require a practice to undertake extra-contractual activities.

On the contrary, CCGs are membership organisations, accountable to their member practices. NHS England will assess the level of engagement and support a CCG has with member practices as part of the authorisation process.

LMCs should work with CCGs to ensure that the relationships CCGs build with practices are constructive, supporting practices to be involved and not mandating engagement.

If LMCs are concerned that the CCG or PCT Cluster is not appropriately involving the LMC or practices in the area in decisions being taken, please email [email protected].


CCG geography

A CCG’s geographical footprint must include all practices in an area and not contain ‘gaps’ within the boundaries. Once CCG boundaries are defined and finalised, the CCG or CCGs a practice is eligible to be a member of will be dictated by geography.

Whilst it would be feasible for a practice on the boundary of a CCG to change membership to a bordering CCG (thus retaining coherent geographical boundaries), practices in the centre of a CCG’s locality would not have this option


CCG constitutions

CCGs are in the process of developing their constitution. A clear and comprehensive constitution will help CCGs ensure they have effective structures, strong governance systems and good relationships with member practices and the local profession.

Find out more about CCG constitutions

Read our CCG constitutions checklist

See also Clinical Commissioning Group constitutions: implications for GPs and practices


The constitution has potential to be an important lever for practices to hold their CCG to account. Through close involvement with their CCG and via pressure from practices, LMCs should ensure that the CCG constitution makes a commitment for the CCG to engage with the LMC, as statutory representatives of the local profession.

LMC involvement in CCGs

Formal LMC involvement in CCGs varies from area to area.

Examples include:

  • The CCG makes a commitment to formally consult the LMC on all pertinent issues. This is potentially far more time-consuming than if the first two options. It also requires the CCG to provide a definition of the issues warranting LMC involvement
  • The LMC is given a non-voting seat on the CCG Board
  • The LMC is given an observer seat on the CCG Board. Whilst this enables the LMC to keep abreast of CCG developments, a downside is that they are unable to contribute to discussions

While the constitution should outline responsibilities of practices as members of the CCG, the responsibilities outlined in the constitution should relate to the practice’s role as a member of a commissioning group and should not stray into general practice contract management or dictate expectations relating to performance.  Although the Health and Social Care Act 2012 does state that CCGs will play a part in improving the quality of primary care.

The LMC should also ensure that the constitution does not contain any inappropriate clauses, such as clauses to expel practices, whether on the grounds of ‘poor performance’ or if they fail to follow CCG policies.

LMCs should support practices where they are not yet satisfied with the content of their constitution and may be coming under pressure from the CCG or PCT Cluster to sign.

LMCs can email the GPC at [email protected] if they need advice.


Democratic processes

CCGs will need to hold elections for important positions. These will include appointments to the elected board, the audit committee, the remuneration committee and the governance body, if different from the elected board.

The LMC, experienced in conducting electoral processes and with excellent links to the local GP profession, is ideally placed to advise CCGs and potentially to conduct CCG elections.

The LMC should ensure that the CCG constitution clearly outlines the roles and responsibilities of the posts for which elections will be necessary and that local GPs are provided with information about the terms of office for each of these posts and how elections will be conducted.

LMCs should ensure that all GPs, regardless of contractual status (partner or sessional) should have the opportunity to stand and vote in elections to CCG positions. This would ensure that the CCG is fully engaging with and has access to the full range of talent within the local profession.

Due to the demands of CCG roles, sessional GPs may have more flexibility to take on these roles than partners and should not be precluded from doing so.


Remuneration for CCG activity

Remuneration for activity undertaken for a CCG, whether for roles at board level or for ad-hoc work undertaken by GPs, should be fair, consistent and transparent. Each CCG will have a remuneration committee to determine remuneration and LMCs should ensure that they are involved in this process.

We recommend that LMCs read the NHS Confederation guidance.


NHS Standard Contract FAQs

Will the use of the NHS Standard Contract change the procurement process? This and other questions on the NHS Standard Contract are answered as well as links to further advice.

Read the NHS Standard Contract FAQs