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How we worked with a ‘mega trust’

I work as the chair of Newham CCG, the product of merger of two pathfinders. We came late on the scene; the CCG had the first board meeting on the second week of July 2012; well after most of the CCGs in the country.

Our authorisation visit was scheduled for four months after the CCG was established. Credit to the small team that at the initial application stage. About six weeks on from our establishment we managed to clear 49 issues in the ‘red’ criteria, leaving us with 70 reds. At the time of the actual visit and exactly four months down the line we managed to have only 18 reds, slightly higher than average to other well established CCG.

The problem

The impact of late start and the process of authorisation resulted in the delay starting to talk to our secondary care provider, Barts Health, a so-called ‘mega trust’ recently formed by merger of several local hospitals including ours at Newham.

Initial discussions were mostly focused more on strategy and principles. But as we worked, we felt we had lost the well-established and focused relationships with local clinicians. With the exception of one or two specialities the clinical interface was minimal.

What we did

We raised our wish to re-established the lost local focus and encourage the clinical debate at various occasions. As a result of our board invitations, we met with the full complement of the Trust’s senior managers and clinicians, including the medical director. (The Trust’s primary care director and local site associate director of primary care are both local GPs.)

After frank and direct discussions we agreed on steps to reinitiate the direct dialogue. One of the immediate results of this meeting was that the Trust are now organising a get-together meeting between GPs and local clinicians. We continue to raise our views at the collaborative commissioning meetings and share our experiences with other London CCGs.


I must admit the Trust reaction was immediate, understanding and focused on improving relationship with local primary care services for the benefit of patients.

They offered to come with the most senior level to any further CCG board meetings, to update and share with us their progresses on communications.

They also shared with us the results of GP survey conducted recently to gage views on the Trust’s services, with also a draft proposal to establish a regular local clinical group meetings involving GPs, clinical leads, terms of reference and accountability arrangements.

During the first board meeting we also agreed to re-establish the ‘service alert’; a pink form we used to use in the past that proved effective in raising areas of clinical concerns, shortfalls in patient services and hospital experience, an immediate reporting mechanism and feedback system for GPs and other primary care workers to use. Any trends and system failures are noted reported on and tackled on ongoing bases.

What is more important is that a senior team including the local clinicians are coming to our monthly regular and well-attended primary care council meetings the main aim is to put faces to the names, to get to know each other and to explain their clinical service strategy and communications with feedback and comments from local GPs. The council meetings are normally lively and promise robust discussions.

We have also agreed to establish clinical service specific meetings with local GPs to have input on the patients and disease pathways and innovations, taking note of Newham’s specific patient demography, health and social needs.

The future

The Trust has proved that they are listening to our concerns, they have reacted with an open attitude and understood our need that in addition to the strategic sector wide discussion, there need to be a locally focused discussions. From long experience in commissioning I am confident that this new found local level meetings and co operations will result in improvement in patient care and communications between primary and secondary care clinicians focusing on service improvements.

I understand and appreciate fears in Lewisham about the creation of a centralised trust but our experience of speaking out about our fears locally has led to us improving our working relationship for the better. Working with a ‘mega trust’ and managing collaborative work within four large CCGs is certainly a challenge, but it can be done.

Dr Zuhair Zarifa is chair of Newham CCG and a GP in Docklands, east London