What will the GPs working in CCGs leave behind when clinical commissioning has been dismantled? Ben Gowland argues that now is the time for them to consider this legacy and to act swiftly and single-mindedly…

This week Simon Stevens exhorted GPs on CCG Governing Bodies to ensure the money promised to general practice reaches its intended destination. He condemned the compounded impact of a decade of disinvestment in primary care, and reaffirmed the necessity of changing the trend to one of investment above the rate of the rest of the NHS. Mr Stevens declared the final destination of the GP Forward View money the responsibility of GPs.

At the same event Professor Steve Field, CQC Chief Inspector of Primary Care, declared an inspectorate for general practice is only needed because local GP leaders have not done their job properly. The CQC is a necessary evil caused only, according to Professor Field, by the failures of local GP leadership.

These declarations will rankle with GPs. CCGs in many areas do not have, and never have had, responsibility for the commissioning of general practice. They are castigated on an almost daily basis for their failure to monitor conflicts of interest thoroughly and effectively, and for allowing their particular part of the system to slide into financial imbalance. And now suddenly we have bewilderment expressed at a national level as to how GPs in the form of CCGs could have been given the purse strings and at the same time allow general practice to fall into its current parlous state.

At the same time, clinical commissioning is being discreetly dismantled. STPs, local accountable care organisations, and devolution are working together to diminish the role of commissioning. Ever since the shift from competition to integration with the publication of the Five Year Forward View, power has been stripped from those attempting to use contractual levers and plurality of provision to effect change. Unachievable financial pressures have been added to CCGs to “even up” the playing field between commissioners and providers, so all can “share the pain equally”.

What is a GP on a CCG Governing Body to make of all of this? What should they do?

It is time to think legacy. It is time to look forward 5 years and think what impact did I have on local general practice? What did I do that made a real difference?

The door has been opened. Simon Stevens and Steve Field are telling you, explicitly, it is your job and your responsibility to support general practice. Take them at their word. Do everything in your power to ensure the GP Forward View money reaches general practice. Reverse the trend of disinvestment and ensure funding for general practice reaches 10 or even 11% of local NHS expenditure.

Hold your own CCG to account for increasing its investment in general practice. Use delegated commissioning to shift the focus of the CCG away from the acute trusts and onto the stated national priority of general practice. Be single minded. Use the opportunity.

Time is limited. You are now being berated at a national, as well as (I assume) a local, level for not using the situation you are in to make a difference to general practice. Stop listening to those who are persuading you the right thing is to forego investment for the sake of financial balance, or that the CCG can’t afford to create its share of the £171m earmarked from core CCG allocations for general practice.

The time for self-sacrifice is over. It is not serving you or your local population. However uncomfortable it feels to say to a room of stakeholders, all desperate for commissioner money, that you have weighed up all their needs and have decided to give it to yourself and your colleagues, that is what you have to do. Putting general practice, primary care and all of out of hospital care first is a national priority. Make it yours.