So how does this simplification look in respect of commissioning?
If you are a Tory MP you will look back to July 2010 and remember a White Paper which rang out loudly with some important truths about getting rid of bureaucracy in the NHS. At the time the Government was announcing its revolutionary plans to reform the NHS. Whilst no-one, including Tory MPs was too clear about what health care problem the reforms were meant to solve, they were at least clear that they wanted to remove layers of bureaucracy form the NHS.
As in the quote above – from the executive summary of the White Paper – there was much talk of decluttering the bureaucratic maze of the NHS.
The Bill enacting this White Paper has now been going through Parliament for a year. So if I were that same Tory MP looking at the architecture of NHS Commissioning from 2013 what would I see?
Let’s pretend that I am that MP, having a cup of coffee with Dr Smith the GP who is chairing his pathfinder Clinical Commissioning Group, and that I ask him what this simplified commissioning will look like.
Dr Smith is assisted in answering this because just last Wednesday David Nicholson met all 50 CEOs of the PCT Clusters to discuss the formation of the NCB and Dr Smith has just been updated.
As an MP I have a real interest in this reform not only because I’m interested in health care for my constituents, but just as importantly from the point of view of democratic representation I want to know where they will go with a constituency problem in the new dispensation.
This is what Dr Smith says,
“It’s a bit complicated. My colleagues and I plan to form a Clinical Commissioning Group that will commission a lot of the NHS care for your entire constituency. I will come back to how we will do that in a minute.
We will however not be commissioning all the NHS care for your constituents. Specialist care for those of them with rare diseases will be commissioned nationally by the National Commissioning Board. The NCB is a new national quango set up under the Bill going through Parliament. The NCB will also be commissioning GP services in your constituency. So if you have a problem with either specialist care or the standard of GP service the body you need to complain to will be the NCB – run from Leeds.
The NCB will have a field force at our local level. Your old local PCT which had a local chair and non-executives has been abolished and formed into a cluster of PCTs. This PCT cluster will now become a part of the National Commissioning Board in our region.
Some NHS Public Health Services will be commissioned by the NCB and some by your local authority. Public Health England – a quango that has been set up under the Bill – will have a further role. Therefore if you have a complaint about the public health services commissioned for your constituent you can go to your local authority, the NCB or Public Health England.
I and my GP colleagues are forming a clinical commissioning group. But before we are allowed to commission any services we will have to be authorised by the National Commissioning Board. We don’t know yet what this authorisation will entail but are starting to plan for it. So if we gain authorisation you will be coming to us with any complaints about the NHS services that we have commissioned for your constituents.
It is however possible that we won’t be authorised by the NCB – in which case a manager from the NCB will be appointed to run commissioning services and you will probably have to take any complaints to the NCB.
As CCGs we will employ some staff ourselves. We are also being told that we have to employ ex-PCT staff that are being formed into Clinical Support Organisations.
If we are authorised we will be working with both our own staff and those from the CSO to develop our commissioning intentions. Before we will be allowed to publish these they will be agreed by another new body – the Health and Well-being Board formed by the local authority.
But before we take it to the Health and Well-being Board we will have to consult the clinical senates that will have been set up by the National Commissioning Board.
So if you don’t like the CCGs commissioning intentions you can complain to the Health and Well-being Board and the Clinical Senate as well as the NCB.”
Whatever else the Bill achieves – no one can see this as simplified.