Almost all general practices in England are part of a NCP, a small group of firms that generally operate in the same geographic area and collaborate under the DES PCN contract to take advantage of some of the benefits of scale work and access to additional financial resources. Responsibility for the commissioning of primary procurement services, including general practice, is formally the responsibility of NHS England. However, over time, clinical commissioning groups (CCCs) have increasingly taken the full or partial transfer of these commissioning powers to primary procurement. This means that most CCGs have at least some responsibility for commissioning general practice on their local territory, while respecting national guidelines to ensure consistency. In order to avoid potentially costly and distracted future claims, it is recommended that constitutions be developed that include a dispute resolution procedure. Such an agreement should be subject to legal advice (which could be sought from members at reduced rates under the BMA Act). Historically, the main levers for setting national or local priorities and implementing service improvement in general practice have been contractual, such as quality and outcome frameworks, and not on the basis of national guidelines. This is still the case, although a rapid transformation of the services offered by family physicians in response to Covid-19 calls into question this assumption. I think THE GP services around Portsmouth are down because they have a call center for 5 or more firms. If they had only one sign in each practice, patients could switch to their operation in a matter of minutes, instead of hanging on for an hour just to make an appointment. Practices forget that they are there for the public, and without us, you would have no practice. Of course, we are living in very different times, which are currently due to the emergence of coronavirus, and that is why, in accordance with national guidelines and CML, we are taking a relaxed approach to the delivery and monitoring of these measures, to make this as simple as possible for practices, to ensure that practical income is protected in these unprecedented times. Practices must cause problems through the appropriate channel with the CGC and not simply refuse to cooperate.

The channels for managing differences of opinion should be drawn in the Constitution. The views of practices within the CGC must be represented as part of the CGC`s decision-making process. Practices must ensure that CGC structures, including democratic processes, accurately reflect the views of GCC members. The Constitution should not include a clause on the contractual responsibilities of family doctors` offices with respect to basic contracts. The practices, through the CML, are expected to exacerbate the problem at NHS England if the CGC refuses to consider the proposed amendments or has not given the opportunity to introduce into decisions on the Constitution. The APMS treaty offers greater flexibility than the other two types of contracts. The MPAS framework provides primary care services to organizations (for example. B private companies or service providers) with other family physicians/family physician associations. APMS contracts can also be used to order other types of primary procurement services that go beyond the general « hard core » practice.