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Commissioning dilemma: Your clinical senate sets an agenda that is too focussed on secondary care

Your clinical senate has set out a strategy for your clinical commissioning group that seems focused on high-quality specialist care, but at the expense of allowing any investment to be redirected to the community. You are unhappy about this direction – is there anything you can do? Dr Stewart Findlay tackles this dilemma.

This is an interesting question and demonstrates how easily CCGs could come in to conflict with their clinical senates. As we work out the membership of senates and their role we will have to be very careful to make sure that it is advisory only. We expect that there will be 15 senates across England.

We will also have to be very careful to avoid adding any further bureaucracy to what is becoming an even more complex commissioning process than the one we are burdened with at present.

It would seem sensible to have leads from each of our clinical networks on the clinical senate but they must also have strong GP representation if they are to have the ability to understand primary and community care and its potential.

We already know that senates will be able to advise on the authorization of CCGs, will be able to comment on their commissioning intentions and may play a part in the annual assessment of CCGs but will not have the right of veto with regard to commissioning decisions. They will have an obvious role in looking a specialist commissioning and the rationalization of hospital services across a region.

The senate will therefore not be in a position to dictate a strategy for a CCG. They will not be the statutory body and will not be in a position to understand the local dynamics and financial position. Any view they might have, can not and will not affect the ultimate responsibility of the CCG to make commissioning decisions on behalf of their local population and at the same time, achieve financial balance.

However, if good working relationships are not in place between CCGs and senates from the outset, we may expend a considerable amount of time in discussion!

Further info on clinical senates can be found in the Dear Colleague letter from the DH, Thursday 15th September 2011, Gateway Reference Number: 16614