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Head in the bill, feet on the ground

The story so far


Dr Peter Weaving, vice chair of Cumbria CCG covering 500,000 patients, has had his enthusiasm for clinical commissioning tested in recent months. Consultant opposition to the NHS reforms culminated in a very public resignation by one secondary care doctor, while PCT staffing has slimmed to a 12th of its original size. Time to reflect perhaps on what keeps him hanging in there…


Dear Peter,

I accept your contract offer of £170m.

Yours sincerely,

Chief exec of acute trust


This is a very short version of a letter I received last week that tells me clinical commissioning is alive and well and functioning in a locality near you, certainly near me. We’re quietly going about our business of commissioning services and distributing the £1bn healthcare in Cumbria costs each year.

Most of that goes in four main contracts with two providers of acute hospital services – your own health economy will be much the same. As part of a CCG you will not hold the budget for primary care as that will sit with your PCT cluster – about to become the local office of the NHS Commissioning Board.

At the same time as receiving the above acute trust letter, consecutive emails from Pulse arrive telling me that the chair of my very own college of GPs is both asking the Prime Minister to work with the college when implementing the bill and asking the House of Lords to withdraw the bill. Meanwhile, the picture is further muddled as the Liberal Democrats’ conference votes against their own Government’s health bill.

Back in the real world of healthcare, we’ve approved over a £100m investment in hospitals and health centres. Some of the most deprived communities in the country will benefit from a new district general hospital.

The flooded primary care services of Cockermouth will move from noisy yellow Portakabins into a purpose-built centre. The whole of secondary care in the north of the county is set to come under the umbrella of the Northumbria NHS trust, which will provide hospital services coast to coast.

On a micro level we’re supporting the development of a poo test – faecal calprotectin – which differentiates your IBS from your IBD. This is a great test for primary care in sorting the wheat from the chaff and reducing the need for invasive colonoscopies and biopsies of the gut, and a great test for secondary care as it can also be used to monitor disease activity in patients already diagnosed.

On a middle level we’re continuing to develop an integrated emergency floor with a common interoperable electronic record across primary care, out-of-hours and secondary care. We’ve reached commissioning agreement on a local sleep apnoea service – currently the poor sleepy patients drive from Carlisle to Barrow, a round trip of 175 miles.

Whatever the final appearance of the NHS, I hold true to the belief that these are all commissioning issues that benefit from the involvement and engagement of clinicians to drive real improvements for patients.