The story so far
Dr Peter Weaving is vice chair of Cumbria CCG, which is on track to get first-wave authorisation status next month. After then, the CCG will be responsible for a cool half a billion pounds.
The plans on how to spend the cash are focused by a three-year integrated strategic commissioning plan. And, of course, everyone is on the same page now… aren’t they?
Bang! Fayyaz’s email crashed into my inbox. I sensed trouble. He is a firebrand in the west, a GP and fellow locality lead for a deprived section of the coast of Cumbria. His style is to cut through the fluff and get to the heart of an issue – he has little truck with the niceties of NHS bureaucracy and his preferred hors de combat is to request the full budget and predict delivery of substantial cost improvements, along the lines of ‘there’s so much b******* waste in the system – just give us the f****** money and we’ll do it for half the price.’
His email didn’t start out well. ‘I’ll be frank and honest,’ he began. ‘I think we need to review what the CCG exec meetings are meant to achieve.’
Uh oh, I thought – the executive group is currently the decision-making body of the CCG, so if we haven’t got that right we are in trouble. There then followed some heartfelt criticism of committees in general and their propensity to generate paper and hot air in equally unhelpful proportions, followed by a slightly unfortunate description of an important medico-social presentation as an ‘info dump’ that could have been condensed to two minutes or one email. And then I remembered – this was a meeting I had chaired. I reached for the agenda hoping to find, with a bit of luck, a defence.
The first section of that meeting had been an informal discussion with the visiting medical director of NHS North, who had painted an interesting picture of primary care of the future – longer consultations but fewer of them, experienced GPs having less direct patient contact and more population overview and strategic planning of their preventive health.
A lot of our current day job would be done by others. The increased funding demanded by the ageing population could only come from tackling the current system inefficiencies to which Fayyaz had so colourfully alluded.
Not just inefficiencies about waste such as medication, but time such as appointments to hear negative results in a world where text and Twitter dictate a different communication expectation.
Next we covered some big-ticket items, including safeguarding (everybody’s problem), the implementation of 111 and consequences thereof (everybody’s problem) and how we could support the primary care infrastructure of our most impoverished population that was currently being crushed by the inverse care law (everybody’s problem).
We then moved onto the somewhat less interesting but no less relevant areas such as performance and finance reports for the whole health economy, including the 10 metrics by which we are compared with our peer CCGs.
We do less well here because, for example, our prescribing – which is generally one of our strengths – becomes an Achilles heel when only our overuse of antibiotics is featured. Our local acute trust meticulously records intensive care unit bed breaches of the mixed-sex accommodation golden rule, unlike many of our other provider trusts, thereby earning us another black mark.
I could go on, but already I feel Fayyaz replying that I sound like a whingeing antipodean complaining about ‘non-swimming countries sending swimmers to the Olympics’.
Finally I come to the item on the agenda I presented, which was an update on our CCG’s journey through the six domains and 184 standards of the authorisation process. Okay Fayyaz, you win.