Risk monitoring reports by the four clustered SHAs dated October 2011 – March 2013, have revealed worries about loss of knowledge due to staff cuts and a ‘loss of grip’ on current performance.
The London papers also identified worries about the lack of a primary care strategy. They read: ‘Roles and responsibilities for primary care commissioning in the new system are still being described. There is a risk that PCT clusters and clinical commissioning groups (CCGs) may not be able to prioritise performance management and improvements in standards of primary care through transition, which may result in greater inequity, poor contractual management and reduced standards of primary care.’
These latest revelations come as the government refuses to follow the ruling last November by the Information Commission to publish the national NHS risk register. The DH’s appeal has launched a tribunal which is due to be heard on March 5 and 6 at the Competition Tribunal in Victoria House, Bloomsbury, central London.
SHA managers in the North of England said GP commissioning could be undermined by ineffective support with a risk of failure to ‘ensure and facilitate the development of effective GP commissioning and transition to the NHS Commissioning Board’.
It added that the proposed changes could mean there is a ‘loss of grip on current performance’.
The South of England report identified there are no current statutory levers to force practices to join CCGs. It added: 'The cluster may lose resource essential to delivering its strategic priorities. This may be apparent in reduced numbers of staff and/or the loss of particular skills and expertise required during the transition, loss of corporate memory, and an increased cost of recruitment.’
Safety is one of the key worries in the North of England cluster with the report stating: ‘Safety is compromised by lack of clarity on accountability, poor staff morale and loss of knowledge due to organisational and structural change.'
Fraud was a problem raised by the East SHA, which said it could be caused by an organisational change resulting in reduced internal control. It added that operation integrity and performance could be compromised as staff are distracted or overloaded as they are focusing on transition. It added: ‘Clinicians do not have the belief, confidence or ambition to embrace change.
‘Given the scale of change and levels of uncertainty we will put out mixed messages and cause confusion.’