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Commissioning groups concentrating on areas patients 'don't give a monkey's' about

By Edward Davie | 28 Oct 2011

A leading GP commissioner and member of the NHS Future Forum panel has warned that red tape is threatening to ‘paralyse' clinical commissioning groups (CCGs).

Speaking at a Reform conference in London, Dr Niti Pall, chair of Pathfinder Healthcare Developments and a GP in Birmingham said: ‘I'm really fed up at the moment because all of the debates we have been having in our local area is about who is going to which cluster with whom and where the CCG boundary will be.'

'We are already half way through a contracting round, spending our money, millions of pounds spent and here we are spending our time talking about what shape we are going to be. It really is frustrating and the patients don't give a monkey's what size or shape or whatever the cluster and CCG is in.'

Dr Pall, who sits on the NHS Future Forum, which has been asked by the Department off Health to explore ways of making the health bill work better in practice, said she was keen to find ways to reduce the ‘burden of red tape' on GP commissioners.

She said: ‘What worries me about delivering commissioning that the patient is at the heart of is the layers of bureaucracy that we seem to be putting into the system. So there is now Health Watch and the Health and Wellbeing Boards and the clinical senates and they have a role to play as long as they don't paralyse us and stop us getting on with the job local people need.'

‘The trouble is that while we wait for all these things to be put in place contracting rounds are going on and the year has gone by and nothing has changed. That has been my experience from fund-holding down to today.'

READERS' COMMENTS

Anonymous, Other NHS,
28 Oct 2011
accountability and oversight, revalidation and whatnot all arise from the same thing - the lack of foresight to allow good planning, the lack of courage in allowing people to do a good job unhindered. Stable door situations.

In a politically driven, corporate society, like ours, you can't escape it.

PCT staff have been expressing these same frustrations for years.
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Anonymous, Manager,
28 Oct 2011
One of the most important tasks a CCG needs to complete is establishing a clear vision of the care it wants to provide to its populace. Just as important though, and often overlooked by GPs, is the need to establish a completely new organisation. Conscious decisions made now, or more likely unconscious decisions made without realising that options were available, will have far reaching effects down the line.

Time spent thinking this through now is not bureaucracy, it is good leadership that would be required for any sizeable new organisation. The worrying aspect is that there are so few clinical leaders that genuinely understand how difficult it is to create a large organisation from scratch. Too many clinical leaders associate management tasks with bureaucracy, choosing to ignore the complexity of management.

I will finish with a cautionary tale about listening to what patients want. Henry Ford once said "If I had asked my customers what they wanted they would have asked for a faster horse". It is not the public's job to work out how we achieve our ends, as long as we can achieve those ends. Clinical leaders need high quality managers alongside them to navigate the choppy waters ahead. Lampooning any thing that does not look immediately like clinical work is short sighted and naive.
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Anonymous, PCT,
31 Oct 2011
I wrote some time ago about the fact that many GPs just want to 'go commission'. I agree totally with the string above that GPs don't want to be embroiled in things they perceive as bureacratic. I would ask GPs to be patient and focus far more strongly on organisational shape and fitness for purpose.

Why? well if you look at overhead costs in any organisation, much of it has been 'designed in'. i.e that the structure has too many departments, too many locations, too many products. The structure is like a tree to hang cost on. Get the right structure and you will save a fortune in the long term.

Do I believe that the White Paper will achieve bureacratic reduction? No - because politicians will pander to the general line and not commission proper organisational design. We will get as many different organisational shapes as there are CCGs. Who will offer to shape CCGs - PCT managers?? no Ernst and Young et al are waiting for your call.

PCT Finance Manager
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Anonymous, PCT,
31 Oct 2011
Dr Niti Pall, chair of Pathfinder Healthcare Developments and a GP in Birmingham said: ‘I'm really fed up at the moment because all of the debates we have been having in our local area is about who is going to which cluster with whom and where the CCG boundary will be.'

And here in lies the fundamental problem that the GP has not grasped. How do you commission services for a population if you dont even know what the population you are commissioning for is? Until you know what your population is, what are the issues and areas of greatest clinical need within that population then you are never going to commission the right mix of services.

It seems to me that there is a basic lack of understanding in this comment, especially given that next years commissioning round hasnt really started yet.
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