Involving General Practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups. In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement.
Design and setting
Survey of a random sample of GPs across England in 2015.
The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2,611 respondents (RR 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future.
Whilst GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next five years, and there is limited appetite amongst those not currently in a formal role to take up such a role in the future. CCGs were set up as ‘membership organisations’ but only a minority of respondents reported feeling that they had ‘ownership’ of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do.
CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting there may be scope for CCGs to involve GPs more fully in roles short of formal leadership.
Strengths and Limitations
• This paper is the first to present the views of a national sample of GPs on clinically-led commissioning from a survey that took place in 2015, three years following the establishment of Clinically Commissioning Groups (CCGs).
• Inclusion of GPs both with and without formal CCG roles allows comparison of views and future intentions and sampling was not restricted according to any regional or CCG boundaries.
• The survey sample contains a slightly higher proportion of older and male GPs than the GP population as a whole while salaried GPs and locums are relatively under-represented.
• The study data focuses on a range of GPs’ views and beliefs about CCG work but is unable to elucidate how responses may have been influenced by local experience of CCG effectiveness or how individual GPs’ motives for undertaking CCG work was reflected in their intention for future participation.
• The survey findings represent a snapshot in time. The policy context in England is changing rapidly, and the views of GPs may be affected by these changes.