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CCGs must prepare for provider failure, says commissioning board director



CCGs must prepare to deal with provider failure in the new commissioning world as they work from a ‘burning platform’ fuelled by financial pressures and increasing demand.

Bob Ricketts, director of commissioning support strategy and market development told yesterday’s London Health 2012 conference: ‘In any system, failure happens.

‘Ideally you try and prevent it, mitigate the effects but actually it needs to be managed.

‘A really key role for CCGs will be to act proactively in local health systems, to actually deal with when Monitor comes knocking on the door and says “you know what, your provider’s in failure/about to go into failure – what are you going to do about it?” They will look to you to come up with those answers.’

Mr Ricketts added the ‘burning platform’ the NHS now finds itself on would require ‘brave commissioning’ and knowing when – and when not to use – competition to deliver real transformational change.

‘You need to understand pricing, nationally and locally, but also new ways ways of transforming services by taking them out of tariff and to be bold enough to do that.’

He urged CCGs to use the commissioning support units (CSUs) to find new ways of contracting such as prime contractor and a new alternative of ‘network’ contracting and ‘looking at five or seven year deals with transformation’.

The conference heard that at the moment CSUs are mostly being used for transactional functions rather than transformational.

Dr Howard Freeman associate medical director for NHS London warned of ‘blood on the carpet’ in the capital, as difficult decisions were made about providers.

He said many CCGs were engaging with all clinicians about how pathways should change but what was more difficult ‘was having had those discussions (about pathways) how do you deal with a provider which actually can’t make those changes.

He added: ‘I think there’s going to be a lot of blood on the carpet in London but I think starting with clinician-to-clinician discussions and getting agreement about how you want services delivered to a population is a very good start, rather than managers talking to managers.’

He said CCGs would need to deal with such tense situations by working in partnership with other CCGs and using the skills of commissioning support units.

Dr Michelle Drage, chief executive of Londonwide LMCs, said she wanted the new system to enable new provider innovation in primary care and that the way for CCGs to engage with GPs was to talk about their day-to-day consultations – particularly those consultations which GPs felt were currently ineffective.

 ‘I want you to enable patients that come through my door to come out feeling better.’ She said.

Andrew Ridley, managing director for North Central and East London commissioning support service said he was ‘struck by how much more present mental health is on CCGs agendas than it was on PCTs.’