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CCG leaders accuse NHS Commissioning Board of promoting 'culture of fear'

Exclusive: CCG leaders have accused the NHS Commissioning Board of operating a ‘command and control’ attitude to management and promoting a ‘culture of fear’.

The leaders said that the NHS Commissioning Board is trying to enforce a one-size-fits-all approach to CCGs, and have criticised the burdensome authorisation process that CCGs have had to go through before they take control in April.

With only 12 days to go until PCTs are abolished, the comments cast doubt on the Government’s claims that clinicians will be in charge of the health service in England and reignites long-standing concerns from GPs that the NHS Commissioning Board will micromanage CCGs.

Speaking at Commissioning Live in Leeds today, Dr Tim Moorhead, chair of NHS Sheffield CCG and a GP in the city, said GPs were at risk of becoming ‘slaves to regulations and rules’ set by the centre.

Answering a question from Pulse, he said: ‘I have a broad perception that the relationship of command and control is still the way that many people in the NHS Commissioning Board still think.

‘The command and control dynamic is really unhelpful. The culture of fear that went with that of which so much has been talked about recently is part of it and is very unhelpful. We need to get away with that enforcement dictated by the centre.’

The Board is trying to enforce a ‘one size fits all’ approach even when very different approaches are needed, such as in South Yorkshire, he said.

Dr Moorhead added: ‘I am aware of the many ways in which multinationals run themselves and they don’t do it by command and control. Even the US army has moved away from that… if the US army can do it, we ought to be able to do it in the NHS and not be slaves to regulations and rules and the culture of fear.

‘I sometimes think the NHS Commissioning Board needs a bit of help to let them know it will be OK if they just let go a little bit, give us the tools to do the job and allows us a little bit of independence. Yes, we ought to be accountable, but I don’t want to be interfered with.’

His sentiments were echoed by Dr Junaid Bajwa, a GP in Plumstead and board member of NHS Greenwich CCG, who said the financial restraints on the NHS were making the organisational changes needed more difficult.

He said: ‘The risks are stacked against you, plus you have the Nicholson challenge. So they have no option in their minds but go to this default position of the hierarchical context of command and control.

‘I hope in the future that it doesn’t stay that way. I hope once they have more trust in CCGs, once the system becomes less fragmented – although it sometimes seems to be more fragmented than it has before – hopefully that will change.’

Dr Bajwa also criticised the authorisation process. He said: ‘As for micromanagement of CCGs – 119 competencies to go through authorisation and you have to score green and reds? I think that is completely micromanaged.’

Dr Nick Balac, chair of NHS Barnsley CCG and a GP in the city, added: ‘In Barnsley, we have poor outcomes and we need to think differently [to Sheffield] to improve those outcomes for our patients. So, regulation – good. But why does it need to be there? Does it need to be that controlling?’

However, he said a bit part of this culture was because CCGs should ‘earn’ their autonomy. He said: ‘I think a lot of area teams are worried about CCGs, about these new organisations. They obviously want to manage risk, they want to manage finance. Some of this is around new relationships… some of that is around demonstrating that CCGs are fit for purpose, some of that is [CCGs] earning autonomy from the [NHS Commissioning Board].’

Readers' comments (4)

  • Vinci Ho

    While so much scrutiny is about the fitness for purpose of CCGs , who and what is there to determine the fitness for purpose of the NHS commissiong board??? For argument sake , if these guys on NCB are to do things to harm the best interests of our patients , who has got the duty of condour to report them, seriously ???? to where????

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  • If CCG's are really going to be distinguishable from their predecessors it must be that clinicians leading them find the courage to say "No" to their apparent bosses! The major running sore in NHS management culture is the knee jerk response to "Jump!" "How high and how far, sir?" If our new clinical leaders do not find the courage to risk their career prospects in NHS management for the sake of the populations they serve, it will be emperor's new clothes all round or a return to "Animal Farm"! We need a major culture change in the aftermath of Mid Staffs, gagging clauses and reports of senior leaders intimidating their juniors, or we will never achieve anything different.

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  • GPs have taken the the bait and are now "apparatchiks" just like the PCT staff they have replaced.
    Tip: You can tell when a politico is lying - their lips move.

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  • There is a currently a piece of work under-way lead by NHS Clinical Commissioners to ensure that NHS CB staff understand what the behaviours are in the new world and to ensure that they deliver on these. NHS CB staff will be appraised from the bottom up and CCGs will be involved in this (see 12 Nov 12)

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