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The Road (yawn) to Authorisation


Dr Peter Weaving is a GP and locality lead in cutting-edge Cumbria. But while something of a commissioning enthusiast, our diarist is also a realist about the scale of the challenge ahead, not least in getting grassroot GPs on board.

A bluebottle buzzed sleepily against the window of our too-sunny seminar room emphasising the drowsiness of proceedings. We were debating the clinical commissioning group's proposed path down the authorisation process to become a stand-alone statutory NHS body. The six GP leads and respective locality directors were variously consulting their Blackberries, texting girlfriends or staring into space. In some ways we'd been at it too long and now had to pass a preliminary test and it was finding us wanting. One of us had even brought a potential medical student along for work-experience who had already sat through the morning's commissioning meeting. Poor sap, he's probably erasing ‘Medicine' from his UCAS form even as I write.

What only a few minds were concentrating on was the job in hand - to fill in the details of a CCG Development Plan that encompassed the six required domains of authorisation. Ostensibly very reasonable, but my eyes kept wandering to the sixth: ‘Great leaders who individually and collectively can make a real difference' which seemed more beatification than authorisation.

Don't get me wrong – I believe in this stuff – that clinical decision making about services and clinical responsibility for resource utilisation is the missing link in an effective health service. What I really struggle with is taking the average clinician's hypercritical, and usually very accurate, assessment of commissioned services and turning it into an abstract description linked to ‘Values/Strategic Direction/Purpose'. I am shocked out of my reverie by loud music as my CCG chair learns how to make his Blackberry play MP3 files but can't find the ‘off' button.

I look through the rest of the domains which are really pretty sensible and cover clinical focus, patient engagement, continuous improvement , governance and collaboration. I cannot fault any of these and, let's face it, you cannot have hundreds of millions of tax payers' pounds sitting in your commissioning grasp without all of these and a darn sight more.

Maybe Domain Six (the leadership one) is describing the saint-like quality for the CCG lead of the future whereby he ‘converts' the GP in his own practice to feel he is responsible for the total healthcare pot and behave on a community rather than an individual basis. The key to making this work at practice level, to me, is the pass-fail for a CCG. You in your consulting room spend £70Bn each year. If I cannot influence and stamp best practice and best use of resources into your heart as a GP commissioner then I am not fit for purpose.

For example only the previous day in my own practice meeting we had a heated debate about a move to discharge patients from routine hospital follow-up and see them ourselves in practice. We know there are a small proportion of patients who, for a variety of reasons, continue to attend hospital when they could realistically be followed-up in primary care – indeed some could be discharged without follow-up of any sort. Now you and I as individual jobbing GPs know this to be perfectly reasonable but ask two or more of us collectively the same question and we will rise up en masse and ask where is the financial incentive to take on this additional work? OUCH!!

My locality director removed her elbow from my ribs. She pointed at the assessment matrix in front of her and the cell containing visible and credible clinical leadership' and crossed out ‘credible' and gently hissed ‘Get with the (Authorisation) programme.'