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CHCs are looking out for the user’s views in GP commissioning

The policy of developing a ‘primary care-led NHS’, which looks likely to continue with Labour’s espousal of locality commissioning, is now raising questions of user and community accountability.

Community health councils, the ‘consumer watchdog’ bodies of the NHS, have not historically had close relationships with primary care, except when they are called on to represent a patient making a complaint. Nor has their right to inspect NHS premises extended to GP surgeries.

But now many CHCs are beginning to forge new relationships with GPs in an attempt to bring the user’s perspective into total purchasing, fundholding and locality commissioning decisions.

Sue Towns, director of the Greater London Association of CHCs, said: ‘A primary care-led NHS implies a fundamental shift in funding and power from health authorities to GPs. At present CHCs have no statutory rights in relation to GPs, and there is little central guidance on involving users in primary care.’

New research published by GLACHC suggests that almost half of the CHCs in London had developed significant relationships with GPs. But it was clear that there were important barriers to such relationships in many areas, not least due to resistance or disinterest from GPs, and many CHCs were uncertain about the value of building such relationships.

‘The CHCs statutory remit should be extended to cover GPs,’ said one CHC chief officer. ‘This would enable CHCs to better monitor GPs and to automatically receive information and have visiting rights.’

While some CHC officers would support this, many would disagree, pointing to the impossibly large workload if CHC members or officers were expected to engage with all the practices in a district.

‘Perhaps working on GP commissioning is not the right way for CHCs to engage with GPs,’ another chief officer said. ‘It is more important to influence the culture of general practice, rather than commissioning activities.’

But Sue Towns points to the need, sooner or later, to face up to the issue of user representation in commissioning. ‘As GP commissioning is extended to cover the majority of the population, constructive relationships between CHCs and GPs will need to be forged,’ she said.

GLACHC is calling for stronger guidelines from the NHS Executive, and wants to see information supplied to GPs explaining the role of CHCs and the importance of involving the local community in planning health care.