CCG Progress - The many successes and the odd failure of our CCG

All of our achievements could be more significant, says Professor Ruth Chambers

Professor Chambers: ‘Our CCG has an excellent relationship with the local authority and public health’ (Photograph: UNP)
Professor Chambers: ‘Our CCG has an excellent relationship with the local authority and public health’ (Photograph: UNP)

The months have raced by since July when we became the clinical commissioning group (CCG) for the 55 practices in Stoke-on-Trent, as opposed to a GP consortium (April 2011) or a practice-based commissioning (PBC) super-cluster (2010/11).

We have been classed as a pathfinder CCG along with around 265 CCGs in England. Our CCG is responsible for £320 million of the overall £520 million commissioning funds for Stoke-on-Trent overseen by the cluster. We are interacting with the other six CCGs in our Staffordshire cluster - one in north Staffordshire and five in south Staffordshire.

It feels as if we are in control of the direction of commissioning priorities, overseeing contracts of services commissioned, service improvement and redesign, and triggering procurement of new services. We are taking increasing ownership of the targets and services we have inherited - especially the £14 million of quality, innovation, prevention and productivity (QIPP) savings for this year and the portion of this to reinvest in additional community services.

What is going well?
The six clinical directors (all GPs) have settled into their leadership roles for non-elective care, planned care, mental health, community services, children's services and practice development and performance, all supported by the CCG chair and lead manager (who has a nursing background).

Transition has been quite easy because we already had good relationships between commissioning managers and the clinicians who previously led on PBC or the professional executive committee; and all of our clinical directors have experience of commissioning or quality improvement. The three CCG localities are functioning and engaging their practices. They evolved from previous PBC groupings, and their lead GPs and practice managers have credibility and respect from local practices.

Our CCG executive committee meets fortnightly with ever expanding meetings to debate proposed service redesign and service improvement, cost efficiencies and population needs. Final decisions are taken by the CCG executive board where other members include lay representatives from local involvement networks, provider trusts, a non-executive director and cluster representatives for finance, quality and organisational development.

The director of public health is a member of the CCG board which ensures public health commissioning input and provides an oversight of critical public health functions and targets while we set up the shadow health and wellbeing board.

Some of the main 'tangible' achievements recognised by those working for the CCG are in the box below. These mainly relate to changes in delivery of acute care - prompter delivery of services to patients and fewer referrals to hospital by GPs - for planned and emergency care.

WHAT HAS BEEN GOING WELL SINCE APRIL 2011?

Quotes from the CCG team

  • Our CCG vision is focused on patient-centred quality of care - not just hitting targets or making finance savings.
  • More co-operative working between CCG and acute hospital for improving and redesigning planned and unplanned care.
  • Increased compliance with maximum 18-week wait. Nine months ago the backlog was 1,100 patients at our local acute hospital, now there are only 378 patients waiting.
  • The backlog of patients whose outpatient follow-up was overdue has dropped from 44,000 nine months ago, to 7,000 patients now.
  • We have contracted for new services in the community, such as minor hand surgery, and some diagnostic services, such as X-ray and ultrasound screening.
  • We are about to launch community-based outpatient services for gynaecology, ENT and dermatology.
  • This year there has been a reduction of around 7% in use of non-elective care at the acute hospital; 6% reduction in delayed discharge of inpatients and 2% saved admissions of children via a new hospital-at-home service.
  • We have an excellent relationship with the local authority and public health.

What is not going so well?
All of our achievements could be more significant - quicker and better services at lower costs, with closer attainment of QIPP targets. But sustaining quality and ensuring that services are patient orientated is central to our vision.

So it depends on how we are judged as to what could be considered as 'not going so well'. Certainly we should do more comprehensive evaluation of the services we commission, especially when we are organising service redesign or improvement.

Then we would know that any changes were worth our investment in terms of quality, and there would not have been unexpected drawbacks, such as poor take-up of new services or destabilisation of any specialty in our local acute hospital.

The future
We must work with our front-line practices to minimise unwarranted clinical variation and not be distracted from this by the plethora of requirements from the clinical commissioning 'industry'.

After all, whatever services we commission or redesign, it is GPs and practice nurses who are the key to directing patients' use of healthcare resources and self-care behaviour.

  • Professor Chambers is clinical director of practice development and performance, NHS Stoke-on-Trent CCG.

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