Across the country, groups of practices have been coming together and identifying the shape and configuration of their CCG. It is a fantastic achievement that these geographies are now sorted and we have emerging CCGs covering the whole of England coming forward for authorisation.
The reforms are based very firmly on three key principles; that patients in their communities should be at the heart of everything we do; that clinicians should be in the driving seat in shaping services; and that we should focus on outcomes based on sound evidence. CCGs are the cornerstone of delivering these aspirations. GP practices know their patients and largely serve specific communities with whom the practice has had a relationship for many years. They already act as the hub of care for their patients; linking patients with other clinicians and ensuring that, through the registered list and the single lifelong record, all the care patients receive is coordinated in one place. This model is envied around the world and is key to delivering better care, better experience, better outcomes and improved safety. So it is only logical that these practices should be at the heart of determining how the range of local services can best meet their patients’ needs.
But good commissioning is mainly about bringing together all those with expertise and an interest in care in order to arrange the services which can deliver these quality outcomes. So the responsibility on the CCG to involve patients and the public, and the full range of health and social care colleagues, is huge.
There is also lots going on to shape the rest of the commissioning system. This means putting in place all the elements of the NHS CB’s own architecture, the national support office, regional teams and local area teams. The NHS CB will be responsible for ensuring the whole commissioning system works well together and that the £80bn of taxpayers’ money is turned into the best possible outcomes for patients. It will support and oversee CCGs who will have the majority of this resource, as well as commissioning specialised services, primary care, prison and military health services, as well as many public health services on behalf of Public Health England.
Another key plank of the systems will be dedicated commissioning support units. While CCGs will be able to buy their support services from whoever they choose, we need to ensure they have the full range available to them from day one. Many independent and third sector organisations can offer fantastic niche commissioning support or highly sophisticated tools and products to aid commissioners. But the capacity and capability to deliver the full range of commissioning support sits with high experienced individuals currently in PCTs, and we must ensure this expertise is supported to deliver the best range of services from which CCGs can choose.
In the final analysis, our success will be predicated on whether healthcare services deliver better outcomes which meet local needs, whether these services deliver integrated care, and whether local communities feel they have a real voice in shaping services which suite them. The key vehicle in ensuring this happens will be the local health and wellbeing board. These vital structures are still in their early development but need to be the focal point for communities, bringing together patient and public representatives, alongside all the players who commission or provide care in the locality, in one place in order to ascertain the needs of the population and outline the overarching strategic plan on which individual components will be based.
There is still much to do in a relatively short space of time. But much is already in place, and we should be optimistic that this greater clinical and patient engagement will bring about the changes we need to see in order to keep improving the quality of care in this difficult economic environment.
GPs and their practices have been placed centre stage in this arena in a way we have never seen previously. CCGs will only be successful if the majority of practices seize this opportunity and make the CCG their own. Their leaders are already emerging, trusted to oversee much of the day to day aspects of clinical commissioning. But without the support of the majority of their practice colleagues their task will be too great. It is the action of all GPs and their practice teams through their connection with their patients, and all others who care for them, which will create a wealth of collective experience which will make the difference.
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