Health bosses are considering whether to give up responsibility for GP contracting after admitting they are in a financially “precarious” position.
Handing back control to NHS England would mean local health commissioners would no longer have the ability to establish new GP surgeries or approve practice mergers in Bristol, North Somerset or South Gloucestershire.
The NHS clinical commissioning group (CCG) for the region took on full responsibility for purchasing local general practice services in April last year.
Bristol, North Somerset and South Gloucestershire CCG was one of 64 in England which willingly assumed “fully delegated primary care medical services” from NHS England.
'An exciting opportunity'
It would make the NHS clinical commissioning group (CCG) for the region the first in the country to hand the responsibility back.
It gave them a range of responsibilities, including commissioning general medical services, performance management of the GP contract, awarding new contracts, and renewing or varying existing ones.
Viewed as an “exciting opportunity” for CCGs to forge closer links with their member GP surgeries, it came with a big budget.
In Bristol, North Somerset and South Gloucestershire, this amounted to around £127million in 2019/20, taking the CCG’s total budget for primary care services to approximately £146million.
But, from that total, the CCG must also foot the bill for a growing number of mandatory national schemes such “improving access to general practice”.
And it now faces a possible £1.6million deficit due to an unexpected possible shortfall in government funding to help pay for market rents and locum payments.
The CCG’s chief executive, Julia Ross, said the financial risk around primary care services was becoming “increasingly untenable” at a public meeting on July 30.
“I’m anxious about the amount of risk that appears to be growing,” she told the CCG’s primary care commissioning committee.
“Our financial position is pretty precarious already.”
Mrs Ross said it was time for the CCG to consider whether it could afford to keep hold of the responsibility for GP contracting or whether it should hand back “delegated primary care medical services” to NHS England.
“It’s not something I’d want to do,” she said. “It’s much better to start to integrate commissioning so we’re able to think about the whole population and pathways right across the population.
“But we have a lot of pressure on our budget already without being handed pressure down from the national system.
'There are equally risks to us not doing it'
“That’s really the problem,” she said. “We know that we want to invest in primary care, but we want to invest more in primary care as part of a whole system development not just in practice contracts.”
The committee agreed the matter would be discussed at a private seminar in August before being raised again at the next meeting of the primary care commissioning committee in September.
Mrs Ross said: “What we’ll need to do in that seminar is weigh up the risks because there are equally risks to us in not doing it.”
The Local Democracy Reporting Service has contacted NHS England to find out whether any CCGs have ever handed back or tried to hand back responsibility for fully delegated primary care medical services.
The CCG’s overall budget for all services in 2019/20 is £1.46billion.
A spokesperson said the CCG’s financial position should be viewed in the context of “significant growth in demand and activity”.
“As a CCG, we need to ensure we achieve the very best value in every decision we make, on behalf of the population we serve and the taxpayer,” he said.
“All partners within the system continue to work together to develop further plans to reduce the financial gap between the cost of delivering healthcare for the BNSSG population, and the overall funding available.”
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