NHS England
The Health and Social Care Act outlined the new structure of the NHS with the abolition of PCTs and SHAs and the establishment of Clinical Commissioning Groups accountable to NHS England which also has responsibility for commissioning all primary care services, including general practice, and some specialist services. Under the Act, it is the NHS England which formally recognises the LMC as the local representative body. However, across most of the country, including Birmingham, CCGs now commission GP services under delegated arrangements from NHS England
NHS England remains responsible for all aspects of professional performance management and investigation, including administration of the GP performers list and GP appraisal, and for the handling of patient complaints about general practice that are reported directly to it, though it may refer complaints back to the practice to handle directly.