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GP Commissioning: dispatches from the frontline

24 November 2011

All over England I hear "does size matter – what is the optimal size for a CCG?"

The simple answer is there isn't one.

Too many of the ‘old guard' are advising, and in some cases directing, expansion or amalgamation of local CCGs in order to mitigate the single risk of running costs. Some are being told that populations of a minimum of 200,000 are required to offset the risk of unexpected high cost individual funding requests.

There are a whole range of risks for developing CCGs that need to be understood. Assurance must be given that these can be dealt with through the authorisation process.

I would suggest that the greatest risk for any CCG is both patient and clinical engagement. PBC struggled and ultimately failed to produce this, mainly because the freedoms and tools to do the job were simply not made available.

If we waste the spirit, enthusiasm and innovation of clinicians this too may be far more damaging than the waste of time, supplies and space.

It's not about building structures – it's about changing culture and the current ‘system' must not determine how healthcare is delivered in the future by applying pressure to recreate the bureaucracy that these reforms are trying to remove. Authorisation must demonstrate that we are moving to a better place.

CCGs must be given the freedoms to form based on the local need of the diverse population in England and an affinity which will effect rapid reform of health delivery.

A one size fits all approach to developing clinical commissioning is not the answer and most importantly has not worked in the past.

Dr James Kingsland OBE is senior partner at the St Hilary Brow Group Practice, Wallasey, Merseyside, National Clinical Lead, NHS Clinical Commissioning Community, and president of the NAPC