CCGs need to stand up to the NCB

Paul Corrigan on what happens next with commissioning now the Health Act has become law.

Paul Corrigan: struggle over the implementation of the Act (Photograph: JH Lancy)
Paul Corrigan: struggle over the implementation of the Act (Photograph: JH Lancy)

The Bill is now an Act and the struggle over its passage will now become a struggle over its implementation.

Now the Bill is an Act, the important tussles that will take place will be around who is implementing it. This may sound like an odd issue to raise because isn't the constitution obvious? The government gets a Bill passed through parliament, the Queen signs the Bill and then the government implements it.

The same ministers who have been pretty hopeless at marshalling the Bill through parliament are now responsible for its implementation.

I know it hasn't looked it for the past 18 months but this group of ministers have had previous experience with legislation in parliament. It was when they were in opposition. Then they would have been involved in the process of arguing amendments and moving legislation through.

But none of these ministers has any experience of implementing an Act while in government. So they are completely new to this phase of the process.

Implementation of legislation
However, the people who run the NHS Commissioning Board (NCB) have been implementing legislation for the past decade.

So if you had to put money on who will have the most efficacy in implementing this Act I would not put much on the ministers' ability to do this.

So if ministers are not capable of this and the NCB will write its own rules for implementation, then surely the field is open to just one sort of implementers - the NCB.

But in fact on the ground there is another group of implementers - the GPs in clinical commissioning groups (CCGs). If they do not implement this Act at all, not a lot new will happen.

And within a few hours of the Bill's passage the combination of the National Association of Primary Care and the NHS Alliance sent out a letter to its members who will be implementing the Act.

In it they make the point that GPs as commissioners now have a choice. They will be implemented to or they will implement. Its letter shows that the two GP organisations plan to short circuit the relationship between what is talked about nationally as policy and what gets done to GPs in practice.

It will have a meeting with the health secretary on 24 April to bring the experience of the actual implementation on the ground and present him with different implementation solutions at both a policy and a practice level.

This means that one of the answers to the question who is going to implement the Act could be the people who are going to carry it out. But only if they are tough enough to stand up to a lot of pressure from the NCB.

  • Paul Corrigan is a management consultant and former adviser to Tony Blair More at www.pauldcorrigan.com

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