Recently a number of GP leaders of local commissioning groups expressed surprise at how they are being treated by arms of the NHS Commissioning Board (NCB) (in the shape of clustered PCTs and SHAs).
Told to come to meetings at a few hours' notice; to change their plans at a weekend's notice and getting a good introduction to the centrist management culture of the NHS.
GPs say in exasperation that this really cannot be an example of what the government means by localisation, can it? And of course they have a point.
How then can a group of local GPs, who are still not properly an organisation, empower themselves to ensure they can achieve something locally?
The one localising part of the Bill that has been strengthened during the government's great reform retreat has been empowering local authorities through health and wellbeing boards.
Across the country, shadow boards are being set up that bring together local government with possible clinical commissioning groups (CCGs), and together they are learning how to think through real partnership working.
Over the next 18 months it will be in the interest of local government and the health and wellbeing boards for their nascent CCGs to thrive. If from April 2013 local CCGs have not been authorised to carry out local NHS commissioning, that commissioning will be nationalised through the NCB. Under those circumstances there will be no local governance of local NHS commissioning at all.
Local government is used to spending a lot of its time battling with central government to ensure that the locality has any say at all in the development of local services. The fact that they will now have to battle with the NCB to gain any influence over local NHS commissioning will be familiar to local government.
Challenges for NCB
Over the next 18 months, local government will increasingly come to recognise this and support their local GPs. However, it would be helpful if local GPs were to recognise that now.
Close links with local government are one of the few power bases that the NCB will not be able to centralise. The NCB will not understand local government or the influences on it.
For the new CCGs this could create a new axis of local power. One that local government is good at. And local GPs need to learn from local government how to stand up for their locality against the power of central government.
- Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com/blog