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Many CCGs 'will struggle in early days', says private sector leader

Many CCGs will initially struggle to get to grips with commissioning, while some doctors realise they are ‘ill equipped’ to deal with the complexity of challenges facing them, according to the head of the NHS Confederation’s private companies network.

David Worskett, director of the NHS partnership network, which represents private companies which run NHS services, urged politicians to take a hands-off approach to CCGs while inexperienced commissioners get their feet under the table

In a debate on GP commissioning at the Conservative Party conference earlier today, Mr Worskett said GPs would struggle with the challenge of commissioning healthcare, with many doctors unprepared for the complex process.

But he said this would only apply to a small number of GPs, as the majority would not play a great role in commissioning and continue to focus on treating patients in their practice.

He said: ‘The reality is most doctors will continue to treat their patients. They will not be spending their time running the NHS. What we’re starting to see instead is that a quite small minority at a certain stage in their career find themselves ready to take on responsibilities like this. This has worked in other professions, and may work in healthcare too.’

‘But commissioning health services is complicated and many doctors come round to the realisation that they are ill equipped for it. There are not many modules on this in medical schools, so quite a lot of CCGs will struggle in their early days.’

Mr Worskett also warned that ‘there will be political troubles’ with the new system, which would require the Government not to ‘lose its nerve’.

‘It will be a major problem to decide what variation is ok and what makes a postcode lottery,’ he predicted.

‘I wonder how easy it will be for politicians to sit back and let these CCGs learn how to get better. I think the biggest risk is it is such a major change to push through. It may not be possible before the political leadership loses its nerve and decides to do something else. I think it is a good move if it can work in the political timescales available.’

To cope with the pressures, and the size of their commissioning areas, Mr Worskett predicted CCGs would increasingly collaborate across area lines, leading to mergers in future.

He said: ‘We will see a lot of CCGs merging, collaborating because they are just not viable buying powers for the size of their patient area. Wouldn’t it be ironic and bizarre if in two or three years’ time we have 152, the number of PCTs we have now.’

Dr Johnny Marshall, interim partnership development director of NHS Clinical Commissioners, a GP in Wendover, Buckinghamshire, said there was a balance to be struck between national political drive and local decision making.

Dr Marshall said: ‘I think it is important that we recognise that the national politics can have an impact on how successful the whole changing of health services could be. We really do need to be looking at a national level, with the support from politicians, at what sort of health services are we looking for in the future. Because the length of time it takes to introduce community services that make the transfer of acute services out into the community safe, it requires several years to do that.’

He added: ‘I don’t think it is about politicians taking a hands-off approach, I think it is to do with what they put their hands on. It is useful for politicians to be involved in what the service of healthcare is going to look like in the future, but if it comes down to getting involved in decisions on a local level then that should rest at the local level.’

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