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At the heart of general practice since 1960

Is this the end for CCGs?

Dr Kailash Chand

In 2010 when Andrew Lansley published his white paper, I wrote an article, concluding that it will all end in tears. In theory,Mr Lansley’s reforms were championing three issues: patients at the centre of the NHS, changing the emphasis from targets to clinical outcomes and empowering health professionals, in particular GPs. In practice, that created only illusive empowerment for GPs and patients. It was a recipe for confusion, inefficiency and demoralisation. The chaotic nature of the reforms meant they needed remedial action to make them workable even before they came into effect.

It appears another reorganisation is inevitable

A meaningless 'top-down re-organisation' by Mr Lansley was the biggest health policy disaster since the inception of the NHS in 1948. As a result, endless workarounds were (and continue to be) created to achieve progress. The history is repeating itself and, the Five Year Forward View is driving a 're-organisation' much more significant and far reaching than that caused by the destructive Lansley NHS Act 2012. The financial climate in the NHS making its urgent implementation necessarily and increasingly another 'top down'.

The latest mantra appears to be the Sustainability and Transformation Plans. What it means is, service redesign and financial robustness on a regional basis to, effectively, the mechanism for delivering that change. Nobody knows how it will work and there is no one implementation programme for this innovation.

However, one thing seems to be clear from the Department of Health and NHS England, that CCGs are unable to fix the underlying problems affecting most health economies. To be precise, the structures created by replacing PCTs and SHAs, at great expense and even greater opportunity cost four years ago are not fit for purpose in the eyes of those responsible for their stewardship. That the creation of STPs is deemed necessary, is also a statement on the effectiveness of NHS England’s own regional operations.

As two thirds of the foundation trusts are in financial meltdown, what limited influence CCGs had on hospitals has virtually disappeared. Most of the powers CCGs have to improve safety and accountability are being clipped. Quite a few CCG chief officers are leaving the sinking ship. Transactional commissioning, which has been the core function of CCGs, is becoming a rare commodity, and with it the sovereignty and agency of local commissioners.

Many CCGs in England are subscale – indeed a significant number of CCGs are struggling for any kind of impact because of their size. I know Simon Stevens, the NHS England chief executive, started his job with the clear message that CCG mergers are not part of his plan. He did not want leadership time consumed by thoughts of organisational restructuring and their own positions. But, this is happening at unstoppable pace.

It appears another reorganisation is inevitable. Changing health economies such as devolution in Manchester, ICOs (integrated care organisations) and the development of accountable care organisations (ACOs) is happening fast.

My fear, this too could end in tears, if, we fail to engage coal face GPs and patients.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP

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Readers' comments (17)

  • Pretty much sums it up....TREACLE being poured into QUICKSAND

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  • For once Kailash, I am in complete agreement with what you have written. It's nice :)

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  • Been in the game for 30years. I have seen FPC, FHSA, PCO, PCT and now CCGs come and go and none make any difference. You can tinker and micromanage all you want.

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  • The underlying problem here is that the amount of money available is simply insufficient to deliver the service as currently specified, taking into account increasing need and the paradigm of 'free at the point of delivery'.

    No configuration including or not including CCGs can perform the magic of getting a quart out of a pint pot. CCGs were originally well-intentioned although chaotically set up; they have been overtaken by the financial issues, happen to be in the limelight as the music is stopping, and no amount of top-down pressure or reorganisation can negate the underlying problem.

    DOI: CCG chair

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  • Nothing changes. If you were the medical director of a PCT that failed, you would get promoted to head the CCG. If they liquidated the CCG, you probably end up as the next Chief Exec or the Health Secretary. If you were a run of the mill GP, you'll still be stagnating in the rut whatever changes.
    NHS is just amazing!

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  • McDonalds is a property business masquerading as a burger franchise.
    For years VW was a hedge fund pretending to make cars.
    The people making money out of the NHS are not those working in it, but using it as a cash-cow to fund their property portfolios and pharmaceutical shares.

    Get over it.

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  • Dr Juneja, you miss the point. This is not about personal failings, it is about a worsening system problem which cannot be solved with reorganisation, which has not been solved with the reorganisation to CCGs and which will not be solved by STPs.

    DOI: Still a GP and not the last PCT medical director!

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  • No doubt there is some wastage of resources in NHS but the main is huge discrepancy between NHS resources and what it is expected to provide. We do need reality check at some level or find lot more resources - professionals as well as funding.

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  • England, as a previously imperial nation is still driven by the architecture of its traditional mindsets and vested interests. It specialises in 'top-down' and eye-wateringly expansive rhetoric and the random juxtaposition of power words that sound good, yet mean nothing. Unless and until such traditions are abandoned and we substitute process-driven practices with relationally and human values-based ones, the pain will continue.
    Process should follow positive relationships, not be 'front-loaded' with relationships being 'forced' on people - that they are currently is dictated by ego-driven, narcissistic, short-term 5 year oppositional politics. There are far more dimensions to life than mere left and right. All the various re-organisational upheavals are based on 'solutions' being imposed on people, rather than their being meaningfully involved in a 'bottom-up' way (I prefer the term 'bubble-up' - which conveys a positive and collaborative energy, not just a direction) are examples of Groundhog Day.
    We are tinkering with the engines on the Titanic, when our discussion and work should revolve around being on board a doomed ship.
    Chris Manning

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  • I am in a minority who think that CCGs as a concept were not necessarily bad. We have far more clinical contact with managers and have been able to prevent unworkable projects and schemes being implemented locally.
    The problem is the NHS financial drought that has occurred at the same time as CCGs. This is what is driving the reflex centralisation, which obviously will also fail.

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