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A faulty production line

CCG view – ‘Many are in this difficult position’

Dr Mary Backhouse, chair of NHS North Somerset CCG, explains how CCGs are struggling to balance the books

We ended up in financial recovery because when we started as a CCG there was already a financial problem. North Somerset PCT was financially challenged so we inherited a deficit.

Part of it is that North Somerset has always been underfunded. Over the two years since the CCG started operation, there has been a recognition of the financial problems, and there has been some movement of money. But we still have a 5% funding shortfall.

We decided to go back to the fundamentals, being really clear about the needs of our population. We have an elderly population, a large number of nursing homes, and drug and alcohol rehabilitation services.

We also looked at benchmarking. For the most part, we found our services are very lean and benchmark well. So we were very clear about the few areas where we were out of line and making sure we were addressing those.

One area was musculoskeletal services. We made sure that right through the pathway people were being referred appropriately.

We’ve introduced the ‘Map of Medicine’ referral tool to all our practices. We are using an interface service, making sure people are being appropriately triaged and that everyone is referred through that process.

We haven’t changed the thresholds for treatment. Things are difficult, and we have to keep reviewing it, but at this stage there has been no change to the thresholds for treatment.

The financial and demographic challenge is so enormous that we cannot find our way out by continually pinching back. The way we see out of it is transformation – looking at the Five Year Forward View, for example.

We are having a lot of conversations about how we address the costs of transformation. A lot of it is helping people understand why we are in the difficulties we are.

Many CCGs are in this difficult place. We are also aware clinician colleagues are in difficult places.

Dr Mary Backhouse is a GP in Bristol and chief clinical officer of NHS North Somerset CCG

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Readers' comments (3)

  • Why do we have a complete split between NHS being free and private health 100% paid for by patients?

    Having a graduation between NHS and private care would allow more patients to receive treatment that is sadly unaffordable when they have to pay 100% of the cost of private health care. Just about everywhere else in the world people can do this

    People can top up social care in the UK so why not NHS health care?

    I can see this happening in the future, perhaps Manchester maybe the first

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  • Who is this guy above? Seems to be posted on every bl**dy article. Have we let the DH trolls in again?

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  • CCGs do seem to under a lot of pressure as they are caught between targets set by NHSE, local demand and cutbacks in community services. You can't satisfy all of the people all of the time. However the proportion of budget that goes to GP is set too low. Does co-commissioning offer a solution here to divert funds to support GPs to cope better with workload and the positive benefits this can bring eg reduced A&E referrals etc.?
    Re graduated fees for healthcare - I know of no country in Western Europe that does that. Healthcare is funded out of insurance as well as taxation in countries such as Germany, but this doesn't deprive the poorest of healthcare nor does it overtax the more wealthy. In Canada in they found that charging fees to see the doctor or for prescriptions reduced appropriate healthcare for poorer and elderly patients with chronic conditions, which led to higher hospital admission rates and healthcare cost. Efficiency and healthcare cost containment is probably best achieved through collaborative innovation through all care pathways, starting with patient at the centre.

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