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Responsibility for GP services in Lambeth 

You will recall the discussions that took place last year regarding co-commissioning of General Practice and in particular your support for “Level 2” joint commissioning at an All Practice Event in early 2015. At the All Practice Event on 20 July 2016 it was noted that we now have an opportunity together with other South East London CCGs, to consider an application for full delegation of General Practice commissioning from 1 April 2017.

The Governing Body is recommending to members that we support an application for level 3 delegation

Colleagues may remember that the options for General Practice commissioning included three levels of delegation:

  • Level 1 – greater involvement in primary care decision making by the CCG
  • Level 2 – joint, or co-commissioning, arrangements between CCG and NHS England
  • Level 3 – full delegation of commissioning to the CCG

Lambeth is currently at level 2 co-commissioning and in the Governing Body we feel that we are now in a position to move forward to Level 3 having considered the benefits and risks in the attached pack. 
At level 3 delegated commissioning, the CCG would take full responsibility for:

  • GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, and taking contractual action)
  • Newly designing enhanced services
  • Design of local incentives schemes as a potential alternative to QOF / DES
  • The ability to establish new GP practices in an area
  • Approving practice mergers
  • Making decisions on ‘discretionary’ payments (e.g. returner/retainer schemes)

As a CCG, we would continue to discharge our normal statutory duties, for example those relating to quality, financial resources and public participation; however, to manage conflicts of interest, the CCG will be expected to establish a ‘primary care commissioning committee’. This would be chaired by a lay member and have a lay and executive majority.

NHS England would continue its assurance role of the CCG to ensure all responsibilities are being adequately discharged and well managed to deliver the intended outcomes. 
Even at level 3, the following responsibilities would remain with NHS England:

  • Holding the medical performers’ list
  • Performers’ appraisal and revalidation
  • Commissioning of dental, community pharmacy and eye health services

The CCG Governing Body is supportive of an application for level 3 delegation. As a follow up to this letter, you will shortly receive an email asking you to cast your vote in respect of the following question: -

Do you support the Governing Body in applying for full delegation of Primary Care Commissioning from April 2017? 

NHS England has asked for initial applications to be made by CCGs for level 3 by 1st November 2016. We will be discussing delegated commissioning at the September / October locality meetings and urge all practices to be represented at the meetings.

We are also holding a borough-wide webinar 1-2pm on Tuesday 27 September.

Please register for this event by using the following link:

In the meantime, we welcome your views and questions regarding this issue. Please contact Dr Adrian McLachlanAndrew Parker or Martin Godfrey for further information and discussion. You can also read questions and answers about co-commissioning from a recent practice event .