Co-commissioning

gp filling in form with patient in consulting room

NHS Brighton and Hove Clinical Commissioning Group (CCG) will decide whether to take on responsibility for commissioning (planning, managing and buying) local GP practice services in late 2016.

While the CCG already has a role under the Health and Social Care Act 2012 to support the quality of GP services in the city, NHS England is currently responsible for funding and managing local General Practice. Under a delegated co-commissioning arrangement, responsibility for the following would pass from NHS England to the CCG:

  • the management of General Practice contracts – including monitoring the performance of local GP practices and taking actions such as issuing improvement notices and removing a contract;
  • approval of practice mergers or changes to individual GP practice boundaries;
  • making decisions on payments and schemes that affect local GPs;
  • making decisions on issues related to GP practice premises.

The co-commissioning of primary medical services (services provided by GP practices) is one of a series of changes set out in the national NHS Five Year Forward View. Since 2015, over half of all CCGs in England have taken on delegated responsibility for GP services, including two Sussex CCGs – High Weald Lewes Havens CCG and Coastal West Sussex CCG.

Brighton and Hove CCG and local GP practices have taken a more cautious approach to date, preferring to take on a greater involvement in primary care decision making with NHS England, without fully delegated responsibility.

Having now seen how delegated responsibility has worked in other areas – and the potential benefits it can offer – Brighton and Hove CCG’s clinical leaders are now supportive of the CCG moving towards co-commissioning in the future.

The CCG is therefore talking to local GPs, GP practice staff and the public about what co-commissioning would mean for GP services in Brighton and Hove.

Delegated commissioning roles and responsibilities

Under delegated commissioning arrangements, the CCG would assume full responsibility for commissioning GP services in Brighton and Hove. A CCG committee would be established to oversee the performance management of GP contracts, as well as budget management and the management of complaints related to local GP services.

NHS England would, however, retain legal liability for the performance of primary medical service commissioning in Brighton and Hove and would therefore retain oversight of the CCG’s committee.

The CCG would be responsible for:

  • Holding GP contracts
  • Contract terminations e.g. in the event of bankruptcy or death of a GP
  • Design of additional services delivered by GP practices and local incentive schemes
  • Establishment of new GP practices
  • Approval of practice mergers
  • Making decisions on any local ‘discretionary’ payments for GP practices
  • Direction on GP practice premises costs
  • Provision of communications and patient engagement advice to GP practices

NHS England would be responsible for:

  • Management of the national performers list (a list that records the training and qualifications of NHS staff in order to make sure they are suitably qualified, have up to date training and have passed other relevant checks)
  • Section 7a (Public Health) functions - for example, national screening and immunisation programmes
  • Capital expenditure functions  - e.g. the allocation of funds for premises improvements
  • Administration of payments to a GP in circumstances where the GP is suspended
  • Management of the revalidation and appraisal process for GPs
  • Various functions in relation to the management of complaints regarding GP services
  • National policy decisions relating to the provision of GP services

Benefits of co-commissioning

It is widely recognised across the NHS that involving CCGs more in the commissioning of general practice provides an opportunity for offering better, more joined-up care for patients and local populations.

CCGs are already responsible for the majority of commissioned healthcare services (including hospital, community, ambulance and mental health services), yet to date have been unable to fully join up their commissioning plans to cover general practice. Instead, they have had to rely on NHS England Area Teams to commission GP services, which, due to their regional nature, often have less local knowledge than CCGs and not as many strong relationships with local GP practices.

Next steps

In preparation for taking on co-commissioning, the CCG will need to ensure it has the necessary resources and processes in place.
Over the coming months, we will be working with NHS England and our member GP practices in the city to agree on: 

  • how the CCG will carry out co-commissioning functions;
  • our local approach to GP contract and service quality monitoring;
  • our local co-commissioning decision-making process, including whether some decisions will be delegated to sub-committees or groups.

We will also be sharing further information on our co-commissioning plans with the public, patients and carers through local Patient Participation Groups, community and voluntary sector groups and Healthwatch and by further updates on this website.