Brighton and Hove doctors to take charge of key decisions about their own pay

Family doctors in Brighton and Hove have been given permission to take key decisions about their own pay and performance, it was announced on Tuesday.

They will have a range of other rights and responsibilities under the arrangement known as co-commissioning, members of the Brighton and Hove Clinical Commissioning Group (CCG) were told.

Fears have been raised about potential and perceived conflicts of interest by local doctors as well as key health organisations such as the King’s Fund.

Questions around possible conflicts of interest were among the reasons local doctors were initially reluctant to take on the extra responsibilities. But last year they voted to take the plunge.

A similar arrangement, known as GP fundholding, was introduced in 1991. It was abolished less than seven years later after a series of criticisms, including by the Audi Commission, an official spending watchdog.

King’s Fund policy fellow Ruth Robertson has written about the latest trend of giving delegated commissioning powers to family doctors.

She wrote: “These new responsibilities shine a light once again on an issue that has plagued CCGs since their inception – the conflict of interest faced by GPs who are buying services from themselves and potentially managing their own contracts.

“CCGs looking to take on greater responsibility for commissioning primary care services would be wise to look back on the experience of GP fundholding.

“That experiment in GP-led commissioning in the 1990s was undermined at least partly by public outrage at claims of GPs lining their own pockets.

“CCGs must demonstrate that they have clear robust governance processes in place that show NHS spending decisions have not been influenced by vested interests, to avoid challenges from providers and the public.”

Brighton and Hove CCG has already set up a Primary Care Commissioning Committee with independent and lay members and a representative of local watchdog Healthwatch Brighton and Hove.

The CCG said: “It is widely recognised across the NHS that involving CCGs more in the commissioning of general practice provides an opportunity for offering better more joined-up care for patients and local populations.”

The CCG also promised greater investment in general practices locally in the coming financial year 2017-18 – and the one after – as part of a five-year plan.