Clinical Commissioning GPs in Charge?
The King’s Fund and the Nuffield Trust have been working with six (anonymous) CCGs over the past four years to gain a real insight into what is going on in the real world, as opposed to that of the press department of the DH. Essentially, CCGs feel that they have managed to gain and hold on to better GP engagement that any of their predecessor bodies, having learned a great deal about how to support improvements in general practice, but fear that times are changing yet again. With Foundation Trust deficits now set to absorb most of the Sustainability & Transformation Fund money – leaving precious little for transformation – NHSE has instructed NHS bodies to “get a grip” on finances. CCGs were invented reduce top-down control in the NHS but precisely the opposite is now happening. When asked in a focus group what message the researchers should take back to government the most frequent response was for more autonomy. There was frustration at the plethora of “must dos” coming out from the centre, wasting time and money, and the concentration on matters of relatively little importance to local populations, “such as the four hour A&E target.” They felt that they were given little time to consult their GP membership let alone other organisations and user groups on rushed initiatives. They asked for more trust and less bureaucracy. They asked that they be given more time to justify their good influence on NHS services but suspected that more structural reforms will soon be imposed, especially on smaller CCGs. Again it was stressed that care will only be able to be delivered more out of hospitals if there is investment in community services. At an operational level, lack of resources was making it difficult to support their clinical leaders to work effectively in general practice. The slowdown in NHS funding growth means that CCGs are having to take “tough decisions” which will make it hard to retain public support. Co-commissioning of primary care is leading to more chance of conflict of interests. CCGs felt uncertain about how much support they could expect from NHSE, the DH and politicians where public unhappiness or concerns arose about either of these. CCGs felt that they were working with “limited resources and little ‘political cover.’” There is growing irritation that CCGs are not being allowed to develop local services for the populations they serve and which their members understand so well, which was their raison d’etre. With the mechanisms of the Lansley legacy looking increasingly inappropriate for present times and a growing funding crisis, not only in the NHS but also in social care (with delayed transfers of care blocking hospitals) and ever more central control, it looks more like the CCG baby will be thrown out with the 2012 Health & Social Care Act bathwater.
Dr Barry Moyse
Deputy Medical Director