GPs outnumbered on commissioning group boards

GPs outnumbered on commissioning group boards:

NHS reorganisation was designed to have GPs making financial decisions, but there are only two or three GPs on some boards
GPs are outnumbered in nearly half the new clinical commissioning group boards, with some clinical commissioning groups having just two or three GPs, according to research carried out by Pulse.
In some parts of the country, GPs made up only a fifth of the boards and were in the minority in 44% of them.
Despite the Department of Health's requirement that each board should include a consultant, the research found very few included. Only 36% of groups had a reserved position for a secondary care doctor – and just seven positions have been filled.
The analysis was based on Freedom of Information requests from 100 groups, which covered more than 1,300 board positions. Researchers said that the figures suggest that groups are failing to engage grassroots GPs, and that practices risk being forced out of the commissioning process.
"In some areas, financial restraints have forced CCGs to actively cut the number of GPs on their boards, despite health secretary Andrew Lansley's insistence that it is GPs who are 'best placed' to improve NHS commissioning," said Pulse, the magazine for health professionals.
Dr George Rae, secretary of Newcastle and North Tyneside local medical committee, said the balance of management staff to GPs had swung too far. "If it is GP-led commissioning, the correct balance isn't GPs in the minority. There are other people who have to have input, but we must not sell ourselves short," he said.
But others have said that the struggle to keep down costs was having an impact on the balance of the boards. For example, Dr Guy Mansford, clinical lead and deputy chair of Nottingham West commissioning group, said practices in his area had decided to cut the number of GP board members from five to two to reduce costs and to counter accusations of a conflict of interest.
"With a large board there is a massive workload for governance, and innovation was just going out of the window," he said. "For small CCGs trying to live within the £25 per head budget, it is very hard to do everything."
Bob Senior, head of medical services at RSM Tenon, an accountancy advisory firm, and chair of the Association of Independent Specialist Medical Accountants, said the £25 management allowance was a factor in the composition of many boards: "The economies of scale don't work so smaller [groups] are having to use that money judiciously, which means you can't have quite as big an involvement from GPs."
The findings are likely to lead to criticism of health secretary Andrew Lansley's plans to put GPs at the helm of NHS commissioning. Commissioning groups will be responsible for some £60bn of NHS budget from April 2013.

The findings

• GPs held 645 out of 1,325 board positions (49%). Managers and finance officers accounted for 267 positions, alongside 140 lay members, 65 nurses, 50 public health representatives, 46 from local authorities, 42 practice managers and 70 others.
• On 44% of commissioning group boards, fewer than half of members were GPs. Groups with the lowest proportion of GPs included Nottingham West, which had two GPs (20%), Bury, with three GPs (21%), and Newcastle, also with three GPs (21%).
• While women do feature on boards, they make up just 21% of board members. Guardian Professional.