Sunday, 7 October 2012

The Site Visit

Despite the fact we had arranged to meet at 8am many of us were there at 7.30.  Having been through the journey towards authorisation together, this was a big day.  As any X-Factor contestant will testify, it 'meant everything,' we'd 'put so much work into it' and we certainly felt like we were about to be judged.  Would we get past the NHS version of Boot Camp?

The site visit, according to the rhetoric, is meant to be supportive, constructive, developmental and a lot of other similar words. All positive.  The training session I'd attended had left me doubtful. Would it just be World Class Commissioning in another form?  Could a team of strangers really learn anything about (judge) our CCG in one day? 

Our anxieties were unfounded.   The tone was set by the panel chair immediately, and was excellent.  At the end of the day I was extremely proud of the CCG team, of their passion in describing patient service improvements and the pragmatism where challenges exist.

My top tips for site visits:

1.     Use the agenda to determine who should attend. Our agenda was very clear, identified which 'Key Lines of Enquiry (KLOEs) would be discussed when, and helped us field a strong team in each breakout session.
2.    Involve other stakeholders where possible. A local authority director of social care attended to describe our joint working and was extremely useful, particularly for the panel local authority representative.
3.    Examine each outstanding KLOE and make sure each is addressed. We prepared an evidence pack for the panel to reference and they found this very helpful.
4.    Use the presentation carefully. It's a short time to focus on the CCG story and subtly deal with as many KLOEs as possible. There's a full day ahead, but many areas that were difficult to get across in a paper submission can be clarified at this point.
5.    Make sure someone in each CCG group is responsible for checking KLOEs are addressed. Our panel were very organised, going through each in turn.  After the training I was worried this wouldn't be the case.  They also stuck to outstanding KLOEs only.
6.    Think what is likely to concern the panel most.  Safeguarding, clinical engagement, financial plans.  We had to emphasise the fact that we'd worked as one organisation with the PCT for over a year, and this was reflected in our policies/plans.
7.    Focus on patients.  All the areas above mean nothing if we don't relate them to patient care, better outcomes.  Identify areas where the CCG has dealt with quality issues, with financial issues, and where patient and clinician input has been effective in producing change.

The site visit was the positive experience it was meant to be.  We are a better CCG for having been through the authorisation journey.  Now to get back to focusing on the actual job, not the process.

Saturday, 6 October 2012

County Hall

It takes me approximately 90 minutes to get to County Hall.  Only 45 miles but traffic, A-roads and the middle of Nottingham have an effect.  Life as a CCG Chair can mean a lot of time on the road, and as I usually do I hoped this meeting would be worth the trip.

Bassetlaw sits between Nottingham and South Yorkshire.  Secondary care flow is north, with 2-tier local authorities, public health, community and mental health services based to the south in Nottinghamshire. It's a complicated arrangement, and is another reason why it's important to have a local commissioning voice for the patients of Bassetlaw.

I reflected as I walked in that I now visit County Hall at least once monthly, often twice. I'd been a student in Nottingham, been to Trent Bridge and Nottingham Forest many times (don't tell my parents, I was studying...) but never noticed the huge building over the road.  It's a world of hushed corridors, paintings of stern looking councillors and, most noticeably, a place where to speak you usually have to press a button on a microphone. If only I could get the children at home to use the same system.

Back to the meeting. Health and Wellbeing Board meets 'Productive Notts', the joint partnership overseeing service change and efficiency within Nottinghamshire.  Was it worth it?  Absolutely.  I often wonder what the term 'clinical commissioner' means.  To me this was what it should mean.  Not about contracts, but working with others to improve services, integrate responsibility and put patients first.  With other CCG leads, we discussed care with chief executives of providers, social care directors and councillors.  The highlight was a presentation by a Professor of Geriatric Medicine.  I was one of his students, but didn't volunteer this as he looked younger than me.

Integration isn't about provision. It's about responsibility.  We shared this in County Hall.  The journey back seemed shorter, with a renewed sense of optimism.