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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.