The Health Bill amendments have actually not changed the emphasis on markets and competition and do move responsibility from the health secretary for what lies on the NHS ‘menu’ to clinical commissioning groups (CCGs) according to independent lawyers.
The NHS Commissioning Board (NCB) has total powers of direction over CCGs such that the legislation needed no amendments at all to allow them to retain accountability for those CCGs which are either not deemed ready or who are not willing to take on formal accountability in April 2013 for an ever challenged Health Care Budget.
The plan for CCGs
For now public expectation is continuously being pumped by the choice agenda with CCGs being told to offer a choice of three providers of community services by next year and the national enforced roll out of 111 services which CCGs must commission despite any conclusive evidence from the pilots that they do anything apart from reduce calls to NHS Direct.
Meanwhile CCGs are told how they must brand and they await a detailed authorisation regime run by the NCB. They await details of how they must include nurses and consultants on their Boards, involve clinical senates, local HealthWatch and health and wellbeing boards into their work plans – does this all add up to empowerment or central direction?
For me who has previously worked in PCGs and PCTs the PCG model allowed GPs and clinicians to get on with what they can really influence – prescribing, referrals, emergency admissions, A&E attendances and improving the quality of primary care provision to patients.
In contrast the PCT engaged me in the bureaucracy so I left.
Where CCGs are now
CCGs increasingly look even more hamstrung by bureaucracy and national edict than the poor PCTs did. They look like being given accountability without authority to make the necessary changes without consulting with a cast of thousands (unless of course like 111 it is central edict when you must just do it or have it done for you).
So why don’t we look at becoming sub-committees of the NCB at local levels with the accountability remaining with the NCB and aligned to the authority they hold over CCGs anyway. GPs and other clinicians can then take on devolved responsibility for getting the most health bangs for our buck and high quality ones too.
That is where our skills lie, not in sailing between the Scylla and Charybdis of Monitor and the NCB and wasting precious NHS resource on forming multitudes of toothless small consortia.
Working together with politicians
The decisions as to what lie on the NHS menu are political not clinical ones, so let’s work with politicians to implement their democratic mandate but not be the fall guys for failing to match limited resources to politically stoked demand.
I love commissioning and do feel a duty to ensure best use of resources but all I see is a mess of legislation and process that is diverting me from my task.
I do intend to make my CCG ready to commission effectively but not necessarily sup from a poisoned chalice.
And of course this sub-committee model is a good each way bet in case the Health Bill falls, which it may well do yet.
- Dr David Jenner, GP Cullompton, Devon and Mid Devon CCG chairman. (The views expressed are his own and not necessarily those of his consortia, PCT or NHS Alliance)