Tuesday, 16 July 2013


Two recent events have persuaded me to write this blog.

1.  A patient recently asked me which doctor at the hospital she should see.  I replied they were all fine, that hers was a routine operation.
But which one, she asked, would listen.  How would she know?  She'd had a bad experience with a consultation in outpatients the year before, and didn't want to repeat it.  What did patients and colleagues think of the consultants in that department?

2.  We discussed the role of the CCG in improving primary care quality recently.  We agreed that the CCG had a unique opportunity, as a membership organisation, to promote transparency, increased peer review, open discussion regarding local services.  

So, on a personal level, I've decided to publish my scores from my revalidation survey.  Thousands of doctors have been revalidated so far.  Would it help patients if results were public?  At least discussed within practices or departments. No doubt there will be those who argue for and against.  Popularity isn't the same as quality.  It is by no means a perfect system.  But there's an opportunity to increase transparency, to publish both peer and patient feedback, and it's at least a debate worth having.

Wednesday, 3 July 2013

Running Costs

As well as a £3.8bn transfer of commissioning money to local authorities, the Spending Review has brought with it a c10% reduction in NHS administration costs.  This is significant for CCGs, providers and patients.

CCG life is getting busier.  We have an ever increasing need for quality assurance, are completing new pathways and leading urgent and integrated care boards with partners.

We have significant public engagement and are active members of Health and Wellbeing boards.  We meet regularly with providers, local clinicians and (of course) report regularly to NHS England area teams.

We are responsible for commissioning budgets which effectively reduce over time with a need to make significant efficiencies - and we are expected to improve quality across primary, secondary and community care. 

I remain optimistic.  Clinical involvement in commissioning is delivering. 

But we need to be realistic about resources.  The £25 running cost is already too blunt a tool, not taking into account size of organisation or local health needs.  The commissioning system has already lost a significant number of experienced staff and is more fragmented.  CCGs are already incredibly lean.  Discretionary effort is part of the job description.  There’s a point where a lean organization becomes an ineffective one.  Patients, and the NHS, needs CCGs to succeed.  

A cut to running costs will make some unsustainable.

CCGs are part of the front line, developing new services, walking the wards and reviewing vulnerable patients in nursing homes.  Their strength is their level of clinical engagement and local knowledge.  Some suggest mergers as the answer. Their size is determined by local patient flows, by local authority boundaries, by consultation with members and patients.  Did large PCTs perform better than smaller ones after their reorganisation? 

Commissioning needs to be local, proactive and patient focused.  Primary care is already feeling the effect of a more fragmented, transactional approach to its own commissioning.  Regulation is important but is not the answer to many of the problems facing the NHS. 

Let’s get commissioners and providers talking, resource them both to do so, and deliver the rewards in efficiency and service quality.