The move to hand primary care commissioning to CCGs has a ‘feeling of déjà vu’ about it, with the new commissioning groups looking very similar to old primary care trusts, NHS England’s director of co-commissioning has admitted.
Speaking at the NHS Alliance conference in London yesterday, Dr Julia Simon, NHS England’s national programme director of primary care co-commissioning, said we are ‘moving in [the] direction’ of reinventing PCTs, with the major difference being the clinical leadership component.
Speaking to Pulse, shadow health secretary Andy Burnham said the comments were ‘final confirmation’ that the Heallth and Social Care Act reforms of the last few years have ‘led us back where we started’.
When the reforms were introduced in 2013, CCGs were prevented from commissioning primary care, mainly as a result of fears over potential conflicts of interests around GPs commissioning primary care.
However, in recent months there has been a move by NHS England and the Government to encourage CCGs to take on responsibility for commissioning and public health.
This was opposed by GPs at the the LMCs Conference in York this year, who warned that a move to co-commissioning would be ‘repeating the mistakes of PCTs’ while the GPC has warned that attempts to put more lay people on CCGs to avoid conflicts of interest would lead to the ‘recreation of PCTs’.
But the comments from Dr Simon are the first instance of an NHS England lead admitting that co-commissioning could lead to the reinvention of PCTs.
Dr David Jenner, NHS Alliance contract lead, asked: ‘Aren’t we reinventing PCTs and isn’t it all going to come back in two or three years anyway? Is it really not the case that actually what we’re saying is CCGs are the successor organisations, will be the local commissioners for a wider range of services, like PCTs again, and for those who are a little reluctant about doing it, it’s probably going to happen anyway?’
Dr Simon replied: ‘I think that’s a very good point. I think that we are moving in that direction. I think a big difference is we have a clinical leadership component now, to commissioning, that we didn’t have during PCTs.
‘But does it have a feeling of déjà vu? Yes I think it does.’
Speaking to Pulse in a personal capacity, Dr Jenner said: ‘The concept of a CCG as a membership organisation is deeply flawed and throws up conflicts of interest when CCGs start co-commissioning primary care… I genuinely think the Health and Social Care Act is the biggest historic mistake in the health service.’’
Mr Burnham told Pulse: ‘Here we have final confirmation that four years on and £3bn spent, we are basically back where we started. What greater admission of failure could there be.’
Dr Sam Everington, chair of Tower Hamlets CCG and a GP, said there were positives around the creation of CCGs.
He said: ‘Clinical engagement is a definite positive, and most trusts were travelling in that direction anyway because it makes sense to have clinician and manager working side by side -all of us see the advantage of that.
‘Secondly, giving local authorities a clear remit around public health and prevention absolutely has to be the right direction.
‘The third one is the new conversation between social care and health care. It’s really important because for a lot of our elderly frail patients the two go hand in hand.’
However, he added: ‘The letter we wrote to Cameron at the time of the election made it very clear that all of this could have been done without this major restructuring.’
This story was edited at 12.47 to clarify Dr Jenner’s statement on the Health and Social Care Act.