The current regulations governing appointments to CCG boards make it too difficult for hospital doctors to be involved, according to the BMA.

The Association linked the low current representation of consultants on CCG boards to the rule that they must not work for hospitals from which the CCG commissions services.

In a letter to Health Minister Lord Howe, the BMA argued this rule is a barrier to the integration of local care.

It pointed to the fact that in July, only 7% of CCG boards included a hospital consultant.

Better integration of primary and secondary care was a concern raised by the BMA during the Government’s ‘listening exercise’, and was the reason for ‘GP consortia’ being renamed CCGs.

The exclusion rule was set by Parliament in June 2012 to prevent conflicts of interest.

However, the BMA’s letter argued: “The regulations prevent CCGs from benefiting from local expertise and formalising valuable relationships with secondary care colleagues.

“They may also cause practical problems by making it difficult for the CCGs to recruit secondary care physicians to these positions.”

Responding to a recent comment by Sir David Nicholson that the NHS CB may need to review the CCG regulations, the BMA said the board should “ regularly review the impact of the geographical restriction on secondary care appointments” to ensure “the value of the secondary care presence” in CCGs was not compromised.

Dame Barbara Hakin, the National Director for Commissioning, believes reduced numbers of doctors on CCG boards is actually a positive development.

The Government’s commissioning tsar was responding after research found that financial restraints were causing CCGs to find alternative board members.

She called CCGs “mature” for searching for a “wide variety of individuals on the governing bodies”.

An investigation by Pulse magazine found that on 44% of CCG boards fewer than half of members were doctors.

Critics argued that GPs were being forced to accept limited roles in overseeing the commissioning process – despite being placed at the heart of the reforms by the Government.

Speaking at the monthly meeting of the NHS Commissioning Board, Dame Barbara said there were actually initial concerns that GPs would dominate CCG boards when the new measures were announced.

“There was, initially, a great degree of concern that because CCGs are membership organisations, built from the basis of the practices… that the governing bodies would be absolutely dominated by GPs and would not start to reflect their communities and key stakeholders,” she said.

“It is interesting that we are starting to get some evidence that the organisations have been really mature and that they aren’t absolutely dominated by GPs.”

CCG governing boards may not include local councillors and must include one secondary care nurse, the NHS Commissioning Board has said.

The new policy tightens the previous ruling that CCG boards had to include one nurse – many CCGs had planned to give the place to a practice nurse.

The nurse must not work for a major provider contracted by the CCG – which has raised concerns about finding suitable people.

Councillors are also excluded by the new governance regulations for CCG boards, to be published in July.

Both decisions reflect tensions between the need to avoid conflicts of interest and the need to bring together the most relevant stakeholders.

The statement on nurse members follows concerns raised by the RCN and others that a practice nurse might be inexperienced and, at worst, a ‘token’ appointment.

Dame Barbara Hakin, National Director of Commissioning Development, said it was important for a nurse to bring a “different perspective” from that of primary care.

As the number of people on a CCG board is unlimited, practice nurses could also be appointed.

The prescribed nurse and acute care medic on the board must not be employed by major local service providers to the CCG.

According to Nursing Times, this means many CCGs may struggle to find suitable people.

Similarly, the exclusion of local councillors will weaken engagement between the NHS and social care.

However, the BMA has confirmed that CCG boards will include GPs: a proposed GP boycott of CCGs was rejected by its Annual Representatives Meeting.