This site is intended for health professionals only

The Senate that Walked by Himself

The story so far

Dr Peter Weaving is vice chair of Cumbria CCG, one of 35 in the country going for first-wave authorisation status this autumn – a move that will make the CCG responsible for a cool half a billion pounds of healthcare throughout Cumbria.

A self-proclaimed commissioning enthusiast, just like everyone else he is still getting his head round what the new health act will mean, how it is best implemented, and whether all players involved are actually necessary...


Now listen and attend, O Best Beloved, for I am going to tell you a tale from when the Health and Social Care Act was so new and all the earth was still steaming and the hot air was slowly clearing.

By a river in a cave lived a GP man and a GP woman. They were very happy, and they made everyone who came to the cave healthy and well and whole again. But one day things changed, and when the GP man went to the mouth of the cave and looked into the countryside, strange beasts and animals had appeared on the hills and valleys.

He called to the GP woman to come and see: ‘Look, woman, the PCTs have flown away – you said that clustering was a bad sign – and the SHAs that were grazing in the meadow have run off... and what are these new animals taking their place?'

Now, the GP woman was not just a GP woman – she was a commissioning GP woman, most wondrous wise, and she threw more wood on the fire and made a magic, a special seeing magic, so she could understand the new animals and their nature. She wanted to know if they could help the GP man be better at making people healthy and well and whole again.

She looked at the animals through her special seeing magic and said to the GP man: ‘Man, that animal there with dewy eyes, floppy ears and an eager-to-please expression is a CCG. Tell it to stop chasing its tail. It can come into the cave and we'll train it to round up trusts.'

And the GP man caught the bouncy CCG and it licked his face as he led it into the cave.

When he came back to stand with the GP woman she said: ‘Man, that animal there with hundreds of eyes, and hundreds of hands and hundreds of feet is a commissioning support service, or CSS. It will help the CCG count the trusts and tell us if they are productive. Take it into the cave and tell it not to wake the baby with its feet.'

And the GP man clapped his hands, and lo! The CSS trotted over and obediently followed him into the cave, carefully tiptoeing past the baby lest it wake.

When the GP man came out again the commissioning GP woman was deep in conversation with an animal like a white llama, with a long neck and head at each end of its body.

‘But you need to understand,' she said to the clinical senate, for that is what it was, O Best Beloved. ‘Why do I need your advice and guidance? The firmament above us has NICE writ large and so clear it can be seen in sunlight. When I look across the land I see the cobweb tracery of clinical networks shot through the fields bringing me news and encouragement, measuring the skill of my GP man at making people healthy and well and whole again. He has a CCG that will sit down with trusts and a CSS so they can understand one another. Is that not enough? I have no need of a clinical senate.'

At that the clinical senate tossed his heads and went on his way; he walked by himself and all places were alike to him.

*With apologies to Rudyard Kipling