How long does it take to achieve a revolution? Amid the rush to authorisation, and the ever-mounting workload from the day job, it’s easy for GPs to forget just how fast and how far the NHS has come over the past two years.
In the early days of the white paper and pathfinder consortia, it seemed almost inconceivable that the unprecedented reforms could proceed at anything like the breakneck pace Andrew Lansley had mandated. But while there remain huge questions over the implementation of GP commissioning – and nagging doubts among many over its rationale – there are now just five and a half months to go until the big handover. Across the length and breadth of England, CCGs are making do, learning as they go and trying to get to grips with the hideously complicated business of taking over from PCTs.
Against this backdrop, then, it might seem a little surprising that the most prominent cheerleaders of GP commissioning are choosing this moment to pour cold water on expectations. Last week Dr Johnny Marshall, former chair of the NAPC and now an adviser to the NHS Commissioning Board, warned it could take five years for most CCGs ‘to develop the necessary relationships and partnerships’. The NHS Alliance’s Dr Michael Dixon largely concurred. ‘It takes time to turn a tanker around,’ he said.
On the ground, many of the GPs who have volunteered to help steer that tanker would no doubt agree. Between managing shrunken budgets, jumping through the NHS Commissioning Board’s hoops and simply setting up their own infrastructure, CCGs are facing a formidable challenge.
Many are struggling even to meet the requirements for board membership, with some being forced to ‘share’ willing consultants and nurses. Some are wrestling with how to effect whole-system change while being given only limited power – as Dr Sam Barrell writes in our opinion section this week. And then there’s the small matter of trying to ‘engage’ a sceptical practice membership while simultaneously making real efficiency savings by cutting referrals and prescribing.
Achieving all that even in five years might seem optimistic – but the chances are, CCGs won’t get five years. Patience is a rare virtue in any part of Government, and in the NHS, perpetual upheaval has become a way of life.
Part of Mr Lansley’s determination to enshrine his reforms in legislation was to ensure they would survive a change in health secretary or even Government – but even he could not have forseen that he would have lost his post before they even began. And when his successor took the stage for his first big speech as health secretary at the Conservative Party conference last week the theme was, inevitably, more change, with a vow to ‘transform the culture of the system’.
GPs who are excited about the possibilities of clinical commissioning will fervently hope for patience from politicans. But even those who harbour grave doubts about the direction of the NHS reforms will be wary of any more wholesale reorganisation. For better or worse, CCGs are poised to start running the NHS. They must be given time to prove they can do so.