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.

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.