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Is it possible that the power of doctors is not as expected in the clinical commissioning team?
In the UK's health service system, clinical commissioned groups (CCGs) have played an important role. Since its establishment in 2012 by the Health and Social Care Act, these institutions have been established to hope that clinicians can lead the planning and implementation of medical services. However, with the dissolution of CCGs in 2022 and a new integrated care system replaced it, does this show that the actual influence of physicians in clinical decision-making is underestimated?
The original intention of CCGs was to allow doctors to influence the distribution of medical resources, but the actual operation was mixed with many administrative intervention components.
According to the 2010 White Paper, GP doctors will take over this commissioned role to fully promote the consideration of patient needs. However, in fact, after several years of operation, many doctors are disappointed with their influence in the CCG. In 2014, only about 20% of GP doctors who do not hold formal positions in CCG said they could have a substantial impact on the work of CCG if they had the opportunity to express their opinions.
In addition, a survey on the internal structure of CCGs shows that although these groups are theoretically led by doctors, there are a large number of managers in the organization and many members are from private healthcare companies, which undoubtedly reduces doctors' dominance and transparency in the medical decision-making process.
According to a 2015 survey of CCG board members, 513 of them were found to be executives of private healthcare companies, which attracted widespread attention to conflicts of interest.
There are different reactions to this phenomenon. In the British Medical Association, experts have pointed out that such arrangements have affected the decisions of CCGs by money and market motivations, and the long-standing trust relationship between doctors and patients may be threatened. Although CCGs claim to be patient-centered, many of their decisions are actually affected by financial constraints and business participants.
Some institutions are even trying to reduce doctors' referrals to some medical services through incentives, which has also sparked controversy over medical ethics. These “controversial financial incentives” have been criticized as trust disruptors of the healthcare profession.
A 2015 survey showed that 33% of CCGs planned to save money by restricting services, meaning patients can be challenged to get due care.
However, in the face of the challenges of the COVID-19 epidemic, the operation of CCGs has changed again, and the government directed the NHS to operate directly and purchase private sector services, which made the role of CCGs more marginalized. Will such a transformation continue, or will it recover as the epidemic ends?
As CCGs are replaced by integrated care systems in 2022, the power and impact of doctors in medical decision-making still seem to be an unsolved puzzle. For many physicians, this decision is particularly unresonant, and they are worried that their expertise and opinions will still be ignored in the new system. Does this show the potential impact of policy shifts on doctors?
Finally, as the medical system continues to evolve, how will doctors position themselves in this new architecture, and will they face the challenge of reallocation of power again?
