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Small clinical commissioning groups (CCGs) are cutting GP board posts and limiting GP involvement because they lack the money to pay for their time, accountants are warning.

Bob Senior, director of medical services at accountancy firm RSM Tenon, told the Commissioning Show 2012 event in Kensington, London, on Wednesday that one CCG in the Midlands had to reduce the number of GPs on its board from six to two.

He said many CCGs are finding it hard to cope with the £25 per patient management funding they receive and are not able to have as much GP engagement as they want.

Mr Senior said: ‘You can’t do everything you want in a small local CCG so as a result CCGs are generally becoming bigger than they originally hoped for. The smaller CCGs are finding that £25 per head is too tight to do anything like the GP involvement they hoped for.

'There is one that I am aware of that had six GPs on the board and they had to cut it to two and I can’t imagine that they are the only ones who have had to make that change.’

'Quality is paramount'
Mr Senior told commissioners that the government believes ‘quality is paramount but you can’t overspend’ and warned that CCGs will retain legal responsibility for services even if they outsource commissioning decisions.

He said: ‘You can use a commissioning support service (CSS) to do a lot of the detailed work but the buck stops with you. You can’t delegate it. [The government] has put a very convoluted phrase in place that basically says there are things that you can authorise but the responsibility still stays with you.

‘You need to do everything better for less money. Getting real time data to stay on budget will be a real challenge for CCGs.

‘You will need to look carefully at contract negotiations and you will have to look carefully at contract terms. Contract management is going to be a very complex area.

‘You will have limited resources. Make sure you get something out of it that you want not what they try to impose. This is your responsibility, your funding, your contract.’

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