Governance and commissioning in localities from now to April 2013.
Filed Under (Clinical Commissioning Groups, Local Government, National Commissioning Board) by Paul on 13-12-2011
Last Wednesday I ran a session with about 60 people in London, all of whom were involved in the governance of NHS commissioning over the next 16 months. As you can imagine, given the confusion around who is commissioning what, there was a broad range of different organisations represented. Most of them were non-executive directors of PCTs, PCT sub-clusters and PCT clusters. This led to much jesting about whether their title would have changed at the end of the meeting from the one they had at the beginning – a whole 2 hours later. (Yes I know – what a sad world I live in where this passes for jest!)
Together with this group were a number of board members from pathfinder CCGs and some local authority members of shadow Health and Wellbeing Boards.
People felt this was a crowded and confusing set of relationships but we agreed that understanding the direction of travel was more important than being able to clearly map a confused and confusing present.
Where do we want to be in April 2013?
One clear part of this future is the role of the National Commissioning Board. We know that the NCB will commission specialist care and GP services and that nationally this will represent about a third of all spend. In London this is much higher because a large number of specialist services are commissioned from the large central London hospitals.
Given that the NCB has this power most of those involved in the existing governance of local commissioning recognised that it would be important for local CCGs to become authorised to fully take on commissioning of local NHS services by 1 April 2013. The thought that galvanised us was that if CCGs failed to become authorised commissioning for their locality would be carried out by the National Commissioning Board.
(Someone tweeted last week that they had heard me say that I expected the NCB on the 1st April 2013 to be commissioning some two thirds of all NHS care – that’s the third mentioned above, and one half of the other two thirds of local NHS commissioning covering those parts of the country where CCGs would fail to become authorised. Do the maths. One third plus half of two thirds is two thirds. Now remind yourself for a moment that this nationalisation of NHS commissioning has been achieved by a Secretary of State who set out to localise power).
The renewed energy in the room last Wednesday came from the fear that their locality could be commissioned by the NCB – which would leave no real local power at all. This unleashed some good ideas about getting local government much more involved with their CCGs. Since then I have heard of three different examples from all over the country of locations where CCGs are getting on very well with local authorities because they recognise that my enemy’s enemy is my friend.
In truth GPs and local government make strange allies. GPs are small private sector businesses and local authorities are large public sector businesses. GPs are a long way from the pressure of directly elected politicians and local authorities are run by them. This is therefore a complex relationship – with a lot of expectation that they just won’t ‘get on’.
So it is interesting that in some places in any case, these two different cultures are getting on. If the opposite were the case and there was a war taking place in the locality, it’s difficult to see how these reforms would work. If the Health and Wellbeing Board wanted to they could really make life hard for local commissioning.
And as I have said before if in the next few months local CCGs are going to become authorised, they will depend upon the help of local Health and Wellbeing Boards to get across the line.
