The time has come, suggests Ben Gowland, for GP leaders in CCGs to consider moving from their role in the CCG to a leadership role in the development of core general practice. 

I have suggested this before.  The reaction seems to be determined by where the individual is sitting: if they are in General Practice without involvement in the CCG they are generally in favour.  However, if they are in a CCG they are generally against.

Initially I thought this was because of the money.  GP sessions are rewarded (often handsomely) by CCGs, to the point where some GP leaders can no longer afford to give up their CCG role.  Indeed, whoever the GP, if their time is no longer funded, it is lost, as it will be swept up in the tides of unrelenting demand on their practice.  I suggested that CCGs continue to fund their time, as part of its work to support the transformation of General Practice, by seconding them back to General Practice.

This would work.  But the objection is not primarily about the funding.  The main objection is the need of the CCGs for GP leaders.  How could there be clinically led commissioning if the GPs are leading the development of core General Practice instead?

Here we get into a debate about priorities.  We have to weigh up two different things.  On the one hand we should consider the influence of commissioning on the system.  If valuable GP leadership time is to be spent in CCGs, it has to be worthwhile.  On the other hand, we should consider the needs of General Practice, and the impact that GP leadership time could have there, and the impact this would have on the system.

Recently Simon Stevens, the Chief Executive of NHS England, has suggested ‘combined authorities’ for the NHS.  He wants to bring together commissioners and providers in order to simplify decision making and service change, based on the 44 STP (system and transformation plan) areas.  What this means is an end to any notion of a ‘commissioner-led’ NHS.  The reality is the NHS is currently regulator-led, and the role of commissioners is becoming increasingly unclear.

General Practice, on the other hand, is deep into a crisis of its own.  In short, demand is up and GP capacity to cope with the demand is down, and costs continue to rise while income has fallen to a smaller and smaller share of total NHS income.  At the same time, General Practice is purported to be at the centre of the new models of care at the heart of the five year forward view for the NHS.

In simple terms, the influence of GPs going forward is likely to be much greater as providers within any new models of care than through any commissioning organisation.  For this influence to become a reality GPs need to be organising a voice around the table, and developing an ability to take on the system integration role envisaged for it.  This requires transformation, and transformation requires GP leadership.

The emotional attachment GP leaders have to the CCGs many of them created is understandable.  But the world has changed significantly in the last few years.  It is time to re-evaluate. It is hard to put CCGs higher up the priority list than the development and transformation of General Practice.  CCGs have developed and are old enough now to cope without the intense parenting they have had so far from their GP leaders.  Now it really is time for these GPs to let go of CCGs and focus their efforts where they are needed most – back home.