liaising with patient representative groups, such as local Healthwatch or the practices' patient participation group. The timing of public involvement is again a matter of broad discretion for the Commissioner. However, any involvement should be meaningful. As such, the Commissioner should involve patients at the time proposals are developed and considered. Overall, it is helpful to bear in mind the "Gunning" principles (these are used to judge whether or not a consultation exercise has been "fair" but are useful when making arrangements for patient and public involvement), as follows: Involvement should take place when the proposal is still at a formative stage; Sufficient information regarding the proposals should be provided, to allow meaningful involvement; Adequate time should be given for consideration of the information provided and for response; The product of the involvement should be conscientiously taken into account by the decision-maker. Separately, bearing in mind the Commissioner's equalities responsibilities, the Commissioner should consider carrying out an Equality Impact Assessment, to check whether any specific groups of people require specific or enhanced forms of involvement. Competition A key question in relation to whether a practice merger raises any competition issues is whether the GP practices cease to be distinct, since for merger control purposes, this means they have to be brought under some form of common ownership or common control. This could happen under certain types of merger model (for example, via a corporate structure), but by no means all. If no one party has a sufficient degree of ownership or control over the practice merger (usually via a shareholding exceeding 25%) then the whole arrangement would remain a contractual one. However, if a party has a 25% or more shareholding, a "relevant merger situation" could be created, meaning that the Competition and Markets Authority ("CMA") would then have the right to examine the practice merger, and whether it poses the risk of a substantial lessening of competition in any market in the UK. There are few recent
liaising with patient representative groups, such as local Healthwatch or the practices' patient participation group. The timing of public involvement is again a matter of broad discretion for the Commissioner. However, any involvement should be meaningful. As such, the Commissioner should involve patients at the time proposals are developed and considered. Overall, it is helpful to bear in mind the "Gunning" principles (these are used to judge whether or not a consultation exercise has been "fair" but are useful when making arrangements for patient and public involvement), as follows: Involvement should take place when the proposal is still at a formative stage; Sufficient information regarding the proposals should be provided, to allow meaningful involvement; Adequate time should be given for consideration of the information provided and for response; The product of the involvement should be conscientiously taken into account by the decision-maker. Separately, bearing in mind the Commissioner's equalities responsibilities, the Commissioner should consider carrying out an Equality Impact Assessment, to check whether any specific groups of people require specific or enhanced forms of involvement. Competition A key question in relation to whether a practice merger raises any competition issues is whether the GP practices cease to be distinct, since for merger control purposes, this means they have to be brought under some form of common ownership or common control. This could happen under certain types of merger model (for example, via a corporate structure), but by no means all. If no one party has a sufficient degree of ownership or control over the practice merger (usually via a shareholding exceeding 25%) then the whole arrangement would remain a contractual one. However, if a party has a 25% or more shareholding, a "relevant merger situation" could be created, meaning that the Competition and Markets Authority ("CMA") would then have the right to examine the practice merger, and whether it poses the risk of a substantial lessening of competition in any market in the UK. There are few recent
Primary-Medical-Care-Policy-Guidance.docx