Throwing down the gauntlet

Dr John Matthews, Chair of NHS North Tyneside Clinical Commissioning Group, explains why he recommends CCG leaders participate in a Health and Wellbeing Board Peer Challenge:

The Health and Wellbeing Boards (HWBs) Peer Challenge is a tool to support local authorities and their health and wellbeing board partners in delivering the best possible services for their local population.

Initiated by the Local Government Association (LGA), as part of the health and wellbeing system improvement programme, it provides a means for local authorities and their HWB, to reflect on and improve their ways of working to take forward key agendas locally. Because of the autonomy a local democratic mandate affords local government (not unlike CCGs), local authorities have been able to work together through their member association to provide a ‘sector-led’ rather than ‘top-down’ improvement programme.

Peer Challenge has much in common with a good NHS professional peer appraisal for doctors and shares the same bonus that the people carrying out the challenge get as much, if not more, out of the process. This was certainly my experience when I was a member of a peer challenge team recently.

There is a well-defined methodology but, in essence, the HWB Peer Challenge Programme supports local authorities and their partners to improve the effectiveness of health and wellbeing boards, so they can be a driver for improving the health and wellbeing for local residents, rather than a talking shop or a hindrance.

There are several key features which mean it is not an inspection:

  • The challenge team is invited by, rather than being foisted on, the local authority.
  • The team is composed of peers, not inspectors or consultants.
  • A report is produced for the benefit of the health and wellbeing board to use themselves, rather than for an inspectorate.

My experience began with a preparatory 1.5 day training event at Warwick University which was very practically orientated with most of the time spent in simulation exercises. Then I was invited to join a four day challenge.

Our team was led by an ex-PCT and local authority chief executive and supported by an LGA manager. Both were very experienced and guided us through the whole process very efficiently.

In three full-on days we had 39 sessions with a total of 9 councillors and 72 staff and partners, had two site visits and referred to 60 documents. We met with people from a great variety of backgrounds including directors, managers and leads from various local government departments, public health, the CCG, providers from health promotion, mental health and acute trusts, community and voluntary sector provider organisations and community representatives.

During the three days we reviewed our findings and developed particular lines of enquiry. On the final day the LGA lead pulled together a summary presentation of our conclusions which was fed back to everyone who had contributed to the process. This is then followed-up by a written report and a review of the impact of the report.

Four days is a long time to commit to a peer challenge. Is it really worth it?

Policy direction and the growing financial challenge across the public sector mean we must achieve closer working between local government and the NHS, with the Better Care Fund presenting all CCGs and local authorities with a tangible and urgent shared challenge to address now. We need to work with a broader range of partners to meet the needs of our local populations, and we need to engage more effectively with individuals and communities. Greater mutual understanding is essential if we are to be effective partners and work together for the benefit of the population that we are mutually responsible for and accountable to.

We are facing challenges in the health and social care sector that could fragment our partnership working and we need to establish robust ways of working together that will withstand these pressures. Health and Wellbeing Boards need to be effective and provide the system leadership to do this.

Finally, as health professionals we are being challenged to support patients in taking more responsibility for looking after their own health and work with them as partners (not just service users). We are more likely to be successful in doing this in a culture where our own organisations take responsibility for improving the services we provide.

A Peer Challenge benefits both the team providing the challenge and the team inviting them, and is an approach to improvement and development that is overdue in the NHS. For me as a CCG and local HWB leader, my experience on a peer challenge team was time well spent.

  • The HWB Peer Challenge programme is seeking CCG leaders to be part of the challenge teams for 2014/15. For further details contact Welna Bowden, at

The next free peer training event is running on 22 and 23 May in Coventry.  Places are also available for training on 2 and 3 October.

John Matthews

Dr John Matthews is Senior Partner and a GP Trainer in Park Road Medical Practice, Wallsend, Tyne and Wear where he has worked for the past twenty two years.

He led the setting up of CareFirst which is a co-operative of 18 GP practices in North Tyneside that work together to improve the care of patients, which has now gone on to merge with another group of practices to form a larger federation.

John is currently Chair of NHS North Tyneside Clinical Commissioning Group which was authorised without conditions.

In this role he sits on the North Tyneside Health and Wellbeing Board which existed in shadow form for two years prior to April 2013. In these two years he chaired the Alternatives to Hospital Admission Partnership Board which focused on promoting integrated care and successfully reducing in-hospital admissions through improved community based urgent care.