The Health and Social Care Act and CCG’s – a brief overview

Post by Anthony Matthews,
NHS campaigner based in Penzance

After much fierce controversy the Health and Social Care Act was passed by the coalition government in 2013 and implemented on 1 April 2013. The government’s cause for such a radical change rested on the premise that the NHS was no longer affordable, and that it needed to be ‘modernised.’

Although for many the Health and Social Care Act remained largely impenetrable, the main thrust was that primary care trusts and strategic health authorities were to be disbanded and in their place clinical commissioning groups – also known as GP consortia – were to take control of about £60bn of the NHS budget and commission local services. Commissioning was to be based on a competitive tendering model which meant that NHS contracts were to be opened up to the private and voluntary sectors – with the government maintaining that involvement of private providers would improve the NHS through competition and price.

Within the new system GPs were to be central to the running of a radically reformed NHS – although what this meant in reality was that health corporates were already gearing up to take on the complex business of commissioning.

One result of these changes is that one tenth of GP surgeries are now privately owned. The 150 primary care trusts have transformed into 211 CCGs and much of the CCGs work is outsourced to ‘commissioning support units (CSUs). The people who work within these groups are not considered to be NHS employees and are not subject to the Freedom of Information Act. By 2016 these services will have been put out to competitive contract.

CCGs and CSUs are monitored by NHS England, an organisation that employs 4,000 people and has 27 local area teams that don’t meet publicly or publish papers. Among the other tiers are the health and wellbeing boards, Healthwatch England, local Healthwatch patient groups (which are prohibited from conducting any campaigning deemed to be political), citizens panels, clinical senates etc. The Royal College of GPs has described the resulting level of accountability as  resembling ‘spaghetti junction’.

Another result of the reforms is that a GP could be constrained from sending a patient to any part of the NHS anywhere in the country for treatment due to a contract with a provider. Many GPs are now issued with targets to lower referrals to hospital. These referrals may have to be passed through a management centre where one in eight are rejected.

The concept of GP control has been eroded to the point where, rather than being in charge, GPs are effectively reduced to rubber stamping decisions made by NHS England and commissioning support services. Only one third of GPs are actively concerned with the work of CCGs and of those more than a third have links with, or shares in, private medical companies and insurers – leading to the phenomenon of the ‘doctorpreneur’.

An important concern is the consequent collapse in morale, with 6 out of 10 GPs now considering early retirement. In the words of Dr Maureen Baker (chair of the RCGP) general practice is now ‘on the verge of extinction.’

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2 comments

  1. Can you explain in a little more detail what you mean by the statement that one in ten GP surgeries is now privately owned? Do you mean the buildings? Or do you mean practices that are owned by private companies rather than the GP partners, so that the company employs all the doctors? I thought that most GP practices still had Independent Contractor status, effectively operating as small businesses owned by the partners and employing salaried partners and practice staff. I would expect that many more than 10% are privately owned in that sense.
    General Practice is not, and never has been, a direct employer of doctors in the way that hospitals and other community services are. It represents a compromise that has worked fairly well for sixty years. A fully salaried service has never been popular with most GPs though those on the left have been calling for it since before 1948. Is the current crisis the result of the administrative burden of running CCGs, hostile take-overs by private investors or underinvestment in the whole NHS which means that GP, which has always been very hard work, is no longer as well remunerated?

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  2. Whilst indeed being ‘independent contractors’ most GPs had been an integral part of the NHS family – trained in the NHS, paid by the NHS and had subscribed to the ethos of public service. The arrangement just about remains, but is in deep peril due to government reforms.
    For the first time private companies can employ salaried doctors to run practices and make a profit from it. When visiting your GP you can never be quite sure who her employer is. Many family doctors now work for companies such as ‘Virgin’ and ‘Care UK’. They might also send you for tests carried out by ‘InHealth’ who run imaging and pathology.
    The current crisis is undoubtedly the result of the administrative burden on GPs, due to the abolition of Primary Care Trusts coupled with the under-investment or ‘defunding’ of the Service.
    For example Polkyth Surgery in St Austell was, reportedly, forced to cancel its contract with the NHS due to financial difficulties, having struggled to cope with long term staff absences – no doubt due to stress – and the pressure of government reforms.

    For more valuable information on the subject click on this link:
    http://www.nhscampaign.org/uploads/documents/NHS%20Unlimited.pdf

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