Tuesday, 2 April 2013

April's here. Why be involved in a CCG?

As we reach April 1st the debate on what the reforms means for the NHS has increased in intensity. With this debate comes, perhaps understandably, challenge to those involved in CCGs - why are we involved, what's in it for us, are we being naive, why not walk away, are we part of the plan to privatise the NHS?

This is my personal perspective.

I believe clinicians should be involved in planning patient services

Clinicians can drive improvements in services by working closely with managers, patients and partners such as local authorities. By focusing on patients and quality we engage others, including local GPs. We are passionate about local services, about improving patient outcomes.

CCG leads know what the challenges are.

I don't feel naive, don't feel used in some master plan. I feel a sense of responsibility to patients, to members and to the local community. I spend a lot of time with other CCG leads - all work extremely hard for patients and any suggestions of naivety does them a disservice.

Commissioning helps me as a doctor.

I'm a stronger patient advocate as a result of commissioning. I'm more aware of pathways, understand local services better. I, and my GP colleagues locally, know much more about local providers and their quality.

The system is more fragmented

From April there are more organisations responsible for commissioning. Patient outcomes and safety must remain the focus. GPs are ideally placed to work with others, to listen to patients, to be powerful patient advocates across the system. CCGs have a crucial role in ensuring the system works.

Walking away would not benefit patients

This is a crucial time for the NHS. Clinical commissioning is an opportunity. Clinicians, from the whole system, should be responsible for planning, as well as delivering, care. My duties as a doctor don't end at my consulting room door.

External roles can be beneficial

There are many external roles, such as working with the BMA or RCGP. All are valid, and can enhance knowledge and job satisfaction. Doctors should not be criticised if they are not consulting full-time. There are many reasons to be part-time, and focusing on population health can deliver significant benefits for patients.

I'm not here to privatise the NHS

There may be occasions when competition is beneficial, or where existing EU law will mean we have to tender for services. However, CCGs are focused on increasing integration to improve quality, as shown in a HSJ survey in 2012. I'm determined to help improve NHS services, to strengthen them.

CCGs deserve professional support

It is important for the profession to support clinical commissioners, to understand their motivations and help build a successful commissioning system with clinicians and patients at the centre. It's an opportunity for General Practice.


  1. The part under 'I'm not here to privatise the NHS' reads like a DoH press release...let's wait until the legal teams come out on behalf of private equity.

  2. Yes, I worry that:
    EU procurement rules + Any Qualified Provider = privatisation, whatever we would like personally.

    My personal belief is that staff providing health services should have decent pay, conditions and a reasonable pension to look forward to, and we've seen those eroded or vanished in adult social care provision over the past 20 years, as the private sector and competitive procurement have come in.

    Of course the private sector can provide excellent services and is generally made up of people with good, caring values. And it can bring investment which - for reasons I never could understand - the public sector struggles to find. Health can probably learn from social care commissioning / contracting colleagues, regarding lessons learned, pitfalls, and ways of keeping the sharks away from contracts with vulnerable people.

    We need strong legal and procurement advice about how we cover all the different aspects of quality - including sustainability, social value, retention of good staff. Too often, legal and procurement advice is only defensive and conservative. The penalties for messing up a procurement decision are high, but so is the consequence of getting the wrong provider.

    The other worry is that privatisation leads to fragmentation, and will be one challenge too far for integrated health and social care.