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NHS management stripped back 'too much' claims Government adviser

The exodus of PCT staff sparked by the NHS reforms has seen too many managers leave the NHS, and is contributing to a lack of expertise in some areas, the Government’s leading GP adviser on commissioning has warned.

Dr James Kingsland, national clinical lead of the NHS Clinical Commissioning Community, and a GP in Wallasey, Merseyside, said CCGs needed experienced managers to prevent GPs from being diverted from redesigning care.

But he told delegates at a Westminster Health Forum seminar yesterday that the NHS management resource had probably been stripped back ‘too much’ and that there was ‘despondency’ in some CCGs about the challenge ahead.

His comments come after commissioning leaders said that CCGs may need up to five years to become successful, and following gloomy warnings from the BMA chair, Dr Mark Porter, that the NHS could be heading towards a worst case scenario where CCGs were ‘disconnected’ from most GPs and operating without grassroots support.

Dr Kingsland also told delegates that he provided regular ‘soft intelligence’ reports to the DH on how CCGs are progressing on the ground, and admitted the current mood was ‘mixed’.

He said some CCG leaders were ‘enthused’, but admitted‘the mood music is mixed’.

‘I’m seeing a lot of misunderstanding, disillusionment and despondency in some areas as well, he explained.

‘We have lost enough [management], probably too much and we need to make sure that the NHS management we have are such that their role is so vital in the redesign of care.

‘Whilst GPs need to be involved in the analysis and the needs assessment of how to secure the best services, we do not expect them to do procurement and contract management - we need NHS managers to do that. We need the right expertise in the right area.’

Dr Kingsland said CCGs jobs would be made easier by the remodelling of secondary tariffs, and addressing the ‘broken’ urgent care system, which he said could partly be addressed by improving access to GP surgeries at weekends. 

‘There is some evidence that extending the primary care system of general practice [opening later and at weekends] can significantly reduce the demand on urgent care,’ he said.

He also told delegates that he believed ‘day to day general practice must change’ when the reforms kick in from April, to take more of a population based approach.

‘The consultation where a patient sits with their clinician is the start of commissioning, that is a needs assessment to give them the best pathway of care,’ he said.

Readers' comments (10)

  • I think after exodus of managers comes exodus of GPs!

    I agree that the NHS is going towards it's worst case scenario, and I can clearly see if we carry on like this, there will be no NHS to manage.

    Maybe that's why some of the management teams have realised it's best to get out and find a decent job earlier rather than later!

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  • Yes, Dr Kingsland is right.

    I should be ashamed of my miniscule 55 hrs working week and only working one late evening each week. I should tell my family I will only be coming back home when I'm on holiday as I now intend to sit in the surgery through out the week 24/7 inorder to improve the access and help lessen the burden on the local urgent care.

    Of course, educating the population about the limited resources and how this should be accessed appropriately or indeed addressing social problems such as poverty and related alcohol/drug abuse will make no difference at all. It simply have to be addressed by GPs working harder (and probably for less).

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  • But, surely this isn't an unintended consequence. As Polly Toynbee pointed out when the legislation first emerged, the NHS has been "wired for demolition". So, everything is running nicely to this government's plan... Pity that GPs didn't spot this back then...

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  • Supply generated demand, Walk in centres, dial a doc and now back to weekend opening?

    Get a grip Andrew

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  • The collective management and operational memory that has just been sent on gardening leave is scandalous. The vacuum left behind is being filled by centralised services with next to no local knowledge. This is going to be, in many areas, catastrophic in terms of CCG development, and if we get paid accurately for QOF, or in a timely fashion at the end of June 2013 I'll be very surprised indeed

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  • Absolutely agree with anonymous. These reforms were always intended to denationalise the Heath service and then leave it open to privatisation. Of course then the blame will fall on GPs for CCG failure. I predict that during this time there will be several changes at the top of the Ministry for Health so no one of our illustrious politicians can be blamed and destroyer of the NHS, All thta was need was replace the majaority of SHA and PCTs directors with clincians. reduce the bureaucracy and micromanagement form the centre

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  • NHS reforms and real cut in red tape costs were doomed to fail as soon as the government announced it and "culled" quangos. Instead of abolishing many, including PCTs they announced that the functions were being transferred to other organisations. The functions DO NOT NEED DOING AT ALL. There is no such this as PCT or Commissioning organisations in Australia, or anything like it. Its lovely.

    Dr Kingston needs to get out and about and see Canada, Australia and NZ to understand he is quite wrong.

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  • The current payment processes are of major concern to current commissioning bodies too - there won't be anyone to authorise payments in June - PCT's etc will be non-existent from March 31!

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  • I left GP world 18 months ago to work in the private sector where I can negotiate my own terms, work late, or not, as I wish and am responsible for my own burnout if I choose to work excessively (which I don't). GPs continue to be at the mercy of beaureaucrats who can heap as much work upon you for no pay as they wish. No wonder so many are leaving the profession. May be privatisation wouldn't be so bad. I won't be returning!

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  • I like the comments from Ulrich Pfieffer and Gerard Bulger above. We keep talking about limited resources and growing demand but what do we do about it?

    We waste money by increasing access to services because we then get unmet need hammering on the door. We waste money by 'commissioning' activity when we should be planning what is required. The latest re-organisation has merely moved the pieces around once more whilst the real issues are ignored.

    Get rid of the Commissioner/Provider divide. Go back to block contracts. Use the private sector and Primary care in a strategic and planned way. Why am I wasting my time....

    PCT Finance Manager

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