The Government is prepared to look again at the feasibility of having local consultants on CCG boards, as long as they can demonstrate no conflicts of interest, NHS chief executive Sir David Nicholson has revealed.
In a keynote speech at the NAPC conference in Birmingham, Sir David also suggested clinical senates could still operate from within CCGs, despite strong hints from ministers that new advisory bodies would sit within the NHS Commissioning Board.
Sir David, who is also chief executive of the new board, said he was 'increasingly optimistic' about the Government's NHS reforms, but said he was still open to discussing amendments to the proposals.
When asked whether he would reconsider the policy of having one consultant on each CCG board from outside the geographical locality, he told delegates: 'I'm happy to look at that again.' But he said the system shouldn't be too fixated on this aspect, adding: 'That's only one bit of it.'
He also indicated there could be movement on how clinical senates work, despite ministers recently hinting that they would sit within the NHS Commissioning Board. 'We are very open to CCGs 'sponsoring' the senate. There will be no blueprint from us. We are happy to host them but you should not see them as an arm of the Commissioning Board.'
Sir David also used his speech to warn GPs they would have to defend potentially unpopular decisions to decommission services.
He said: 'The big challenge is around how tough some of these decisions are going to be. We are already seeing some of these, such as the configuration of services in Barking, Havering and Redbridge. We know a significant amount of the productivity and quality gains will be about changing the nature of some of these services. These will be tough decisions.'
‘It's mission critical, both in terms of shifting services into the community or centralising some services in provider organisations. You will find yourselves in town halls discussing and debating this. That's very tough to do, but absolutely vital.'
He warned hospitals they would need to 'completely re-think their business models' to adjust to urgently required redesigns of services.
'There is a challenge for providers. Their success in the past was built on growth. Many of them are now getting that it's changed, but not all by any stretch of the imagination. They need to completely re-think their business model.'
Dr Phil Moore, vice chair of Kingston Commissioning group, said commissioners faced a huge challenge in implementing innovative service re-design because of the reluctance to destabilise secondary care.
Dr Moore told Sir David: 'We need to push commissioning boundaries, at times we need to destablise or threaten to destabilise, otherwise we're not pushing the boundaries far enough.'