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CCGs a 'déjà vu’ of PCTs, NHS England lead says

The move to hand primary care commissioning to CCGs has a ‘feeling of déjà vu’ about it, with the new commissioning groups looking very similar to old primary care trusts, NHS England’s director of co-commissioning has admitted.

Speaking at the NHS Alliance conference in London yesterday, Dr Julia Simon, NHS England’s national programme director of primary care co-commissioning, said we are ‘moving in [the] direction’ of reinventing PCTs, with the major difference being the clinical leadership component.

Speaking to Pulse, shadow health secretary Andy Burnham said the comments were ‘final confirmation’ that the Heallth and Social Care Act reforms of the last few years have ‘led us back where we started’.

When the reforms were introduced in 2013, CCGs were prevented from commissioning primary care, mainly as a result of fears over potential conflicts of interests around GPs commissioning primary care.

However, in recent months there has been a move by NHS England and the Government to encourage CCGs to take on responsibility for commissioning and public health.

This was opposed by GPs at the the LMCs Conference in York this year, who warned that a move to co-commissioning would be ‘repeating the mistakes of PCTs’ while the GPC has warned that attempts to put more lay people on CCGs to avoid conflicts of interest would lead to the ‘recreation of PCTs’.

But the comments from Dr Simon are the first instance of an NHS England lead admitting that co-commissioning could lead to the reinvention of PCTs.

Dr David Jenner, NHS Alliance contract lead, asked: ‘Aren’t we reinventing PCTs and isn’t it all going to come back in two or three years anyway? Is it really not the case that actually what we’re saying is CCGs are the successor organisations, will be the local commissioners for a wider range of services, like PCTs again, and for those who are a little reluctant about doing it, it’s probably going to happen anyway?’

Dr Simon replied: ‘I think that’s a very good point. I think that we are moving in that direction. I think a big difference is we have a clinical leadership component now, to commissioning, that we didn’t have during PCTs.

‘But does it have a feeling of déjà vu? Yes I think it does.’

Speaking to Pulse in a personal capacity, Dr Jenner said: ‘The concept of a CCG as a membership organisation is deeply flawed and throws up conflicts of interest when CCGs start co-commissioning primary care… I genuinely think the Health and Social Care Act is the biggest historic mistake in the health service.’’

Mr Burnham told Pulse: ‘Here we have final confirmation that four years on and £3bn spent, we are basically back where we started. What greater admission of failure could there be.’

Dr Sam Everington, chair of Tower Hamlets CCG and a GP, said there were positives around the creation of CCGs.

He said: ‘Clinical engagement is a definite positive, and most trusts were travelling in that direction anyway because it makes sense to have clinician and manager working side by side -all of us see the advantage of that.

‘Secondly, giving local authorities a clear remit around public health and prevention absolutely has to be the right direction.

‘The third one is the new conversation between social care and health care. It’s really important because for a lot of our elderly frail patients the two go hand in hand.’

However, he added: ‘The letter we wrote to Cameron at the time of the election made it very clear that all of this could have been done without this major restructuring.’

This story was edited at 12.47 to clarify Dr Jenner’s statement on the Health and Social Care Act.

Readers' comments (12)

  • So yet again a government that claims to be short of money can find £2 Billion to spend re-arranging the desks for nothing more than a vanity project.
    Well done Mr Lansley, you must be so proud.

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  • And PCT's a dejavu of Health Authorities!!

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  • .................and the band played on.

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  • Phil Yates

    Deeply depressing. Huge upheaval when all that was needed was to 'de-bureaucratise' PCT Executives and allow the clinical leadership its head. It's not only the financial cost that's wasted, it's the enormous expenditure of person-hours recreating structures and recruiting to them and the opportunity-cost there's been in not getting on with the commissioning job of improving services for patients.

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  • Dr David Barrett

    Coca-Cola and Pepsi, can barely tell the difference...

    Just a crazy waste of money, which could have gone to front-line services and perhaps at least "taken the edege of" the mess we're in now.

    "Re-arranging deck chairs on the Titanic" also comes to mind.

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  • Actually slightly misquoted ,I said the Health and Social Care act was biggest mistake in NHS ,membership structure of CCgs creates difficulties with conflict of interest if CCGs commisison primary care again -a non GP majority on the board can address some of that but I felt most GPs were not wedded to memebrship structure of GPs and this would be worth Pulse running a survey to check. I thought most Gps were interested in innovative models of provision rather than commisisoing (and all in personal capacity) And as Mr Hunt had announced CCGs should commisison Public Health too,this really did look like the old PCTs and that clinicians could be effectively engaged with them through Proffesional Eexecutive Committes rather than necessarily a membership arrangement.

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  • So on the face of it the worse case scenario is £3bn wasted and we are back where we started. No. They have pushed the "talent" from the PCTs into more stable sectors, they have wasted enormous amounts of doctor time that could have been spent with patients and they have frittered away what little enthusiasm there was amongst clinical leads to change things for the better. Look at the tattered remnants of the NHS and general practice now - we are not back where we started Mr Burnham.

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  • We are not back where we started, we are a long way behind.
    The money for this disgraceful circular mess has effectively come from front line budgets, GPs have been pilloried in the press for things they had no control over, and a very large number of GPs ( myself included) have walked and will not come back.
    Wasted money, wasted goodwill and a much worse situation in terms of recruitment and morale.
    Well done!

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  • Question: How many nurses, GPs, hip replacements and re-furbishments of unsuitable premises could have been paid for with £3 billion pounds????

    Answer: A LOT!

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  • Plus ca change.............
    The main point is that the politicians have yet again further distanced themselves from the painful rationing decisions which lie ahead.

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