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Commissioning dilemma: The only consultant who volunteers to sit on your board is a retired eccentric

The only consultant who volunteers to sit on your board is a retired eccentric, with a good reputation among his specialist colleagues, but no understanding of primary care. You know attempting to block his appointment would cause ill feeling among your hospital colleagues. Should you attempt to do so? Dr Stewart Findlay advises.

Following the listening exercise, the Governing Board of every Clinical Commissioning Group, has to include one nurse and one hospital consultant. However neither can work for a local provider organization.

This may be a difficult post to fill and the situation described above may well happen in some areas. I think it will be difficult to recruit consultants from outside the area and it may well be that our only option is to consider someone that has recently retired.

A CCG finding itself in the difficult situation above will have to consider the following options.

The first is attempt to block the appointment. All candidates will have to be interviewed and demonstrate that they are competent to sit on a commissioning board. A basic understanding of primary care could be an essential requirement. One might also argue that even a retired local consultant, having worked for a local FT, may still be considered to have a conflict of interest because of his/her relationship with the trust managers and their former colleagues.

Any upset caused by this decision would soon be forgotten but it would still leave you without a candidate for your Board.

The alternative is obviously to appoint. The advantage would be that you will then have the support of local consultants and they would feel they have a strong voice on your board. It could potentially cement relationships between primary and secondary care.

The consultant will however have to play his/her part as a board member of a statutory body. He/she will share responsibility for achieving financial balance for the CCG and will have to abide by majority decisions. Once they have assumed this responsibility they will have to develop an understanding of primary care and will be expected to demonstrate that they are at all times acting in the best interest of the CCG.

The best decision may therefore be to appoint and to develop this consultant as a board member. At best they will become a valuable asset. At worst they can always be outvoted!

Dr Stewart Findlay is chair of Durham Dales  Shadow CCG