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
