The M Word - Issue 10 - Dr Michelle Drage's latest personal briefing for practices on NHS reforms

Dear Colleague 

Another April, Another New NHS 

But this time it’s huge, so please see below for some sanity which I have drawn up from the perspective of practices as providers of General Practice.M Word issue 10 April 2013


  1. Changes to NHS structures and functions
  2. Changes to your GP provider contracts and performance arrangements
  3. Providing continuity and support through the changes


Please feel free to send your comments and thoughts to


My best wishes
Dr Michelle Drage FRCGP
CEO Londonwide LMCs


1. Changes to NHS structures and functions

  • No more PCTs and Health Authorities to deal with.
  • Instead it’s CCGs (Clinical Commissioning Groups) and the London Regional Office of NHS England (ie, the new brand name of the NHS Commissioning Board, or NHSCB).
  • The CCG of which your practice is statutorily a member bound by constitution, has the power to commission non-GP services (hospitals and community), local enhanced services and equivalents, and a duty to improve the quality of primary medical services, ie, your services.
  • Local Authorities (LAs) with their new remit for Public Health, and their ability to commission local enhanced services and equivalents.


2. Changes to your GP provider contracts and performance arrangements

  • Imposed changes to your GMS and PMS contracts with effect from 1 April 2013. These centre on QOF, DESs and Pensions. We are advised that the GPC is currently putting together a Survival Guide for publication (keep a check on their website for further information).
  • The ability of CCGs and LAs to commission services from commercial and other non-GMS or PMS providers using the AQP (Any Qualified Provider) or competitive tendering routes.
  • Although CCGs have a duty to improve the quality of primary medical services, an aim we all share, the CCG does not have the statutory remit to performance manage your GMS and PMS contracts. That will sit with the NHSE London Area Team.
  • Regulation and performance management of your contract, payments and your Performer’s List status is not with CCGs, but is direct from NHS England in accordance with its Single Operating Framework, via its London Regional Office, covering the three London Sectors. We will give you contact details for individual Area Teams when we have them!


3. Providing continuity and support through the changes

  • Your local borough LMC will be more important than ever to you in working to secure local enhanced services contracts and equivalents from CCGs and LAs, as well as monitoring their effectiveness in commissioning services to support and not undermine your provider roles and responsibilities.
  • Londonwide LMCs will continue to be here to support local borough LMCs; you and your practice as these changes bed in and beyond; work to influence the way the new NHS systems treat general practice going forward; and to provide training for practice teams to feel more in control of the impact of these changes (stay informed by visiting
Last updated : 29 May 2013


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