GPs in Surrey Downs are to vote on whether to apply to the NHS for greater powers to commission under-pressure primary care services.

In an interview with the Epsom Guardian last month, Miles Freeman, chief officer of Surrey Downs Clinical Commissioning Group (SDCCG), said it aimed to apply for "joint commissioning" with NHS England to have a greater say over the area’s primary care.

CCGs were set up by the 2012 Health and Social Care Act as GP organisations responsible for buying the majority of an area’s secondary care such as hospital services.

They replaced primary care trusts, which were dissolved last April, and are overseen by NHS England.

The latter has retained control over primary care commissioning, which covers GP surgeries.

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Mr Freeman said that, when the CCGs were set up, the responsibility of primary care remained with NHS England because of the suspicions surrounding any potential conflicts of interests arising from GP-led bodies commissioning care from GP surgeries.

He said: "Conflict of interest is something you can manage relatively straight-forwardly.

"It's quite difficult to sensibly commission services without having some GP input into what they deliver. It's silly.

"But we recognise the conflict of interest.

"The guidance around it is you need to have executive and lay member majorities to make sure it's not GPs deciding to award themselves pay rises effectively.

"In the first year of CCGs there was an awful lot of nervousness that CCGs were new organisations, that they could all be very different, that you could end up with some very rogue ones who might do something very dodgy.

"Most CCGs have proven they've got governance in place to be able to manage that.

"Now I think the move is to push primary care commissioning back to CCGs.

"However that's going to be quite a difficult thing to do because a lot of general practice aren’t that convinced about being a membership organisation and they're quite worried about the relationship with the CCG if it takes over their main contract.

"They also feel they've had strength through having a national contract with a national organisation - national collective bargaining."

The chief officer said that, in order for SDCCG to apply to NHS England for joint commissioning powers, three-quarters of its GP surgeries would need to be in favour of the change.

A vote on the issue will be held among the CCG's 33 practices - in areas including Epsom, Ewell, Ashtead, Banstead and Esher - by the end of this month.

Mr Freeman, who has worked in NHS commissioning for the past 12 years and was previously a residential social worker, believes joint commissioning would benefit SDCCG.

"NHS England is where the financial responsibility remains, but we would be involved in the decision-making," he said.

"At the moment we will have some things which are pointed at the same area.

"Simon Stevens [appointed chief executive of the NHS last April] wants place-based commissioning so he believes CCGs should be responsible for the majority of the health needs within their area and he thinks the way we've got a fragmentation between some services being delivered by NHS England around primary care and then us commissioning between primary and tertiary run services, he just thinks it's unhelpful because you stop having some of the levers in the system."

Mr Freeman said premises from which primary care services are delivered is one area which would benefit from CCG-level input.

"We've had a big increase in the cost of our property since we started. £4.7m a year we spend on some of the community properties where services are delivered from," he said.

"We've got vacancies, voids, there are areas where the estates are in poor condition and we might be able to redevelop and areas where we might want to aggregate services.

"It's not always brilliant to try to deliver the same service from four of five different sites with different teams. It's an expensive way to do it.

"If we were freeing up parts of different sites I would like to be able to do that, with the opportunity of a partial land sale to provide a capital receipt to potentially build a new GP surgery.

"[Under the current system] you would have to go NHS England to bring the deal together and the problem is when it goes to its Kent, Surrey and Sussex area team they're not going to have the staff or the local knowledge."

In July, this newspaper reported on how thousands of patients could be left without a much-needed GP surgery in the heart of Epsom because the NHS’ Surrey and Sussex area team had not considered an application for new premises by the Ashley Centre surgery for more than a year.

It said it was waiting for policy guidance on the issue from NHS England and, while it wanted to see greater investment in primary care, "finding money in one area will inevitably mean reductions elsewhere".

Mr Freeman said he does not believe there has been any headway on the issue nationally.

"In the first year [of CCGs], there was no real process for anyone to apply to get to move to new premises.

"In the second year, they've designed a process but there's been no funding," he said.

"NHS England has been under some financial pressure and I think part of it is behind Simon Stevens' design to get CCG's to take on primary care commissioning.

"Trying to assess what your premises priorities might be outside of your overall strategy is quite difficult and these things, if you're doing them in an area team at Kent, Surrey and Sussex level, and you're talking several hundred general practices, to actually know the area and understand the number of CCG's different strategies, it isn't very sensible."

Do you think Surrey Downs CCG should have greater powers to commission primary care services?

Contact Hardeep Matharu by emailing, calling 020 8722 6234 or tweeting @Hardeep_Matharu