It's been a hairy couple of months for our diarist as tensions mount between the CCG and hospital consultants. But he's hanging in there...
The story so far Dr Peter Weaving, a self-confessed commissioning enthusiast, is a locality lead in Cumbria and has just been elected vice chair of a newly formed Cumbria CCG that will cover six localities and a population of 500,000. Keen to pursue what clinical commissioning can achieve, he is also a realist about the scale of the challenges ahead and how the changes will be received by others…
Tonight, I'm back in the bear pit of the medical staff committee – the consultants' committee of my local district general hospital – to address the audience on the uncontroversially named subject of ‘the potential collapse of secondary care in the county'. The main speaker's first slide is a photograph of a car crash. This follows a couple of months of gloomy local headlines about the situation locally culminating in ‘Top doc gagged', when their chair was asked to desist from speaking directly to the media and consequently resigned.
The straw for my camel's back was a comment from a fellow GP on Pulse's online coverage of the same story. In the readers' comments box, the GP wrote: ‘Yes, you get to be commissioners – but your local hospitals collapse. Happy now?'
I'm looking forward to the debate tonight, which I expect will go over the same ground we covered nine months ago – because not a lot has changed. We are closer to CCGs taking the reins from PCTs as local commissioners of healthcare, but the rest of the NHS rules and infrastructure have not changed much and are unlikely to with the passage of the health bill. And it will be the underlying rules of the NHS, some of which were devised and debated in the 1970s, that I will be revisiting tonight.
Firstly, and essentially, the amount of healthcare funding coming into the county is determined by a complex resource allocation formula that was first written when I was a medical student, is now in its seventh iteration and runs to exactly 100 pages. It's great for appropriately accounting for deprivation, but poor on the health consequences of rurality – but apart from me in Cumbria and you in Cornwall, who cares about that?
Next, I'll discuss how that money is distributed to secondary care organisations according to the latest Payment by Results document. You will all have to hand the 2012/13 version, an easy read at 182 pages. As you know, dear commissioner, hospital services are reimbursed according to the number of patients seen, the complexity of their conditions and the treatment they receive.
So that is the iambic pentameter of the sonnet of the health service. What is then written in that meter, the actual detail of the local services, is a discussion between the commissioners and the providers.
Again, I look forward to the debate around this with my colleagues tonight. Reading the local headlines, which do influence the health-seeking public, one would be justified in thinking things are bad – but the reality for the hospitals is that they are developing cardiac services locally to repatriate patients who currently have to travel to the far side of the country, there hasn't been an MRSA bacteraemia for 18 months, they've got a lower joint revision rate than centres of orthopaedic excellence and they're successfully recruiting top-notch consultants.