Dr Mike Bewick, medical director, NHS Cumbria and a GP in Egremont explains how the senate works in his area.
The Cumbria senate was set up just over two years ago for a different purpose than the one now being proposed. It´s a federation which co-ordinates the work of six locality commissioning groups, serving a population of around 500,000 across a large geographical area with long travel times and wide variation in health.
We were probably one of the first areas to develop one. We wanted a united approach to commissioning but recognising that each locality had different issues. We wanted to be able to ensure equity and fair shares around the patch and secondly, to be able to share risk. If someone tried something somewhere and it didn´t come off, then the others would be able to support them.
The senate has so far been developing evidence-based clinical pathways and service models, giving peer support to localities to help improve their performance. It has been collaborating for both commissioning and contracting and also working with key public sector partners.
Our senate effectively replaced the PCT´s Professional Executive Committee – although the PEC has continued to exist for legal reasons. Where we differ from them though, is that the clinical senate is actually the commissioning body.
The membership includes the key commissioners from our six localities – Allerdale, Carlisle, Copeland, Eden, Furness and South Lakeland – and will include co-opted secondary care consultant and a senior nurse. We´ve always had lay members and a non-executive director too.
We´ve had a shadow Health and Wellbeing Board for a number of years but it´s likely that the Health and Wellbeing Board will assume greater significance now. The amendments to the Health and Social Care bill mean we will now have to take cognizance of the Health and Wellbeing Board and the needs assessment they produce.
The senate will have to send representation to the Health and Wellbeing Board to make sure we take cognizance of the needs assessment.
In terms of the role the government now envisages for clinical senates, there is a worry that they will turn into another PEC – and PECs find it very hard to get things done. There is perhaps a danger, that we´ll have to go to several other layers to get things done.
However, we´re making sure that the clinical senate is the senior commissioning body for all six localities. Ours has a purchasing role. It can be quite powerful if it´s done properly.