Recommendation 123

General Practitioners undertaking a monitoring role

GPs need to undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services. They should be an independent, professionally qualified check on the quality of service, in particular in relation to an assessment of outcomes. They need to have internal systems enabling them to be aware of patterns of concern, so that they do not merely treat each case on its individual merits. They have a responsibility to all their patients to keep themselves informed of the standard of service available at various providers in order to make patients’ choice reality.  A GP’s duty to a patient does not end on referral to hospital, but is a continuing relationship. They will need to take this continuing partnership with their patients seriously if they are to be successful commissioners.

GPs, both in their roles as care providers and in clinical commissioning groups, should be continuously reviewing the quality of care provided by the acute hospital and specialised services they commission. NHS England continues to develop relevant guidance and tools for clinical commissioning groups to monitor the quality of service provision and support continuous improvement in quality.

Clinical commissioning groups are under an important duty to assist and support NHS England in securing continuous improvement in the quality of primary medical services. They will need to do this working alongside the NHS England area teams, local Healthwatch and other parts of the system. NHS England and clinical commissioning groups are developing a framework for commissioning for quality, through the NHS Commissioning Assembly, which will set out the steps that commissioners should take to assure themselves and their patients that the services that they are commissioning are safe, clinically effective and result in a positive experience for patients. This will be published in autumn 2013.

Clinical commissioning groups in a local area will be part of the new local quality surveillance groups, where they should share information and intelligence with other parts of the local system. If they have concerns about whether providers are meeting the essential standards of quality and safety, they should raise these with the Care Quality Commission and with any other parts of the system with an interest through that group. This should include concerns they have about providers from whom they do not commission services, such as primary care providers, but with whom they interact”

There are other mechanisms through which GPs can report concerns about services. As health professionals, GPs are able to exercise their discretion when updating patient records, to incorporate comments on a patient’s care, and patients themselves will be able to gain online access to their GP record by 2015.

In addition, NHS providers should be publishing online aggregated feedback on the quality of care delivered by their organisation, and we would expect GPs to make themselves aware of this feedback and to use it to advice patients on their care. NHS England are undertaking further work to improve and increase the level of patient safety incident reporting to the National Reporting and Learning System by GPs through work with the Primary Care Patient Safety Expert Group and as part of the Strategic Framework for Commissioning Primary Care. Finally, any serious incidents that GPs identify should be reported to the NHS SI reporting system, the Strategic Executive Information System, as set out in the NHS England Serious Incident Framework published in March 2013.

The clinical commissioning groups authorisation process was built around six domains, and was developed by working with clinical commissioning groups, national primary care organisation and other stakeholders. Assessing clinical commissioning groups through these six domains provides assurance that clinical commissioning groups can safely discharge their statutory responsibilities for commissioning healthcare services. They are also intended to encourage clinical commissioning groups to be organisations that are clinically led and driven by clinical added value.

One domain, ‘meaningful engagement with patients, carers and their communities’ specifically looked at how clinical commissioning groups could show how they will ensure inclusion of patients, carers, public communities of interest and geography, health and wellbeing boards and local authorities. This included showing their mechanisms for gaining a broad range of views then analysing and acting on these. It should be evident how the views of individual patients are translated into commissioning decisions and how the voice of each practice population will be sought and acted on.

One of NHS England’s key functions is to develop the assurance process which identifies how well clinical commissioning groups are performing against their plans to improve services and deliver better outcomes for patients, as well as working together to assess how they can realise their full potential and provide support on that journey. Sitting alongside NHS England as fellow commissioners, clinical commissioning groups need to secure quality today and transform services for the future.

And we will go even further in clarifying the role of the GP in coordinating patient care. On 5 July 2013, the Secretary of State for Health announced an intention that every vulnerable older person should will have a named clinician responsible for overseeing their care at all times when they are out of hospital, whether they are at home or in a care home. Through the work to develop a vulnerable older people’s plan, the Department of Health is working with NHS England and others to look at how we can achieve better integrated, coordinated out of hospital care.

To do this role well, clinicians both inside and outside of hospitals will have to work together to share information and provide a seamless, integrated pathway of care to patients. A part of the work to develop a vulnerable older people’s plan is about making sure that information can be shared between services and people providing care in a coordinated and timely way, including all clinicians and carers having access to the same information about patients regardless of setting.

When the NHS has got this right for older people – those who need healthcare services the most and who often have complex health and care needs – this should become a much broader transformation in out of hospital care – one which will eventually help every NHS patient.


NHS England has continued to develop relevant guidance and tools for clinical commissioning groups, to support them in monitoring the quality of service provision and in driving continuous improvement in quality. A framework for commissioning for quality, Commissioning for Quality – Views from Commissioners was published in July 2014.

In Transforming Primary Care (April 2014), the Department of Health and NHS England set out how the Secretary of State for Health’s vision for a vulnerable older people’s plan and better integrated out of hospital care will be put into practice, including a named GP for all people aged 75 and over since June 2014. Since September 2014 GPs have also take the lead in developing a proactive and personalised programme of care and support for over 800,000 people with the most complex needs.

By Spring 2015 every patient will be able to see their records, test results, book appointments and order repeat prescriptions online. They will also be able to communicate with their GP practice electronically. This will support a greater transparency for patients about their care and treatment and make it easier for patients to access details about their care and its outcome.