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Why does conformity and size trump performance and vision when it comes to CCGs?

It turns out that size does matter. Farewell to a battling minnow: the country's smallest commissioning group - the single practice based Red House CCG - is barred from progress due to new Government legislation.

Now this might seem a little strange when viewed from the early days of the NHS reforms when Andrew Lansley was trumpeting the fact that his new plans would ensure that GPs and their patients would influence the way the NHS delivered for them. He promised we would be able to make changes that would improve the experience for all.

‘No decision about me without me' was the soundbite, but unless David Nicholson is going to attend our local patients  group meeting that phrase sounds as hollow as a chocolate Easter egg. His view of a bottom up approach to health care gone exactly that - bottom up.

Now the news may be as sad as the demise of Rutland CCG but in all honesty will it mean anything to general practitioners other than the ending of a rather cute anachronism?

I hope so. In representing the opening ideals of the reforms, Red House CCG set to achieve their aims and reconfigure services to meet the needs of the patient body that they serve - not through endless meetings where the vested interests of some meet the intransigence of others, but by rapid consensual application of common interests.

In the year and a bit we have been working as a CCG we have

·      Protected our patients from discriminatory blocks to secondary care service

·      Brought the hospital based audiology service in house so patients can now get hearing tests, hearing aids and follow-up tailored to suit their needs.

·      Enhanced primary care dermatology

·      Set up new mental health services, focussing on medically unexplained symptoms

·      Created  and commissioned a in-practice new allergy service.

The fact that these can be identified in conjunction with our patient representative, designed commissioned and set up within a year demonstrates the flexibility that small groups offer.

The temptation for all commissioners is to start with grand redesigns of major heath care issues. These end up being mired in complexity and are often so detailed that it is impossible to measure the outcome of the new and putatively more economical way of doing things.  Starting small and sensitive allows a feeling of what actually works (and saves money) to be gathered and to build on these achievement.

For example, at present we have a diabetes reconfiguration bid waiting for PCT approval. It took one doctor's hard work with innovative thinking three months to get the whole scheme laid out with links to both hospital and community service. A previous scheme took nearly 3 years and still has not delivered any benefits to our practice.

The key to all of this process is consensual commitment.  At a time when the ability of CCGs to consult and reflect  their constituent practices varies, and when dissent with decisions may be ignored this is indeed a golden key. The desire to change and the motivation to engage with change constructively and productively is something that we have demonstrated is vital to success.

Clearly, there are very successful commissioning groups run but very competent and engaging managers and they will hold the hopes of both Government and GPs as they set about the tasks mandated to them by the NHS Act.

For us, as a small and soon-to-be disbarred commissioning group, the future will involve trying to ensure that our achievements develop and realise their true potential.

This will offer mutual benefit:

·      As a locality we can maintain our cohesive approach and continue to develop innovative ways of delivering services in more efficient and economical ways

·      We can offer savings of time and money to a commissioning group within which we sit

·      We can be the perfect  structure in which to pilot new ideas and models before rolling out through the whole CCG

·      We, in turn, can benefit from the autonomy that preserving a locality status will confer.

At the risk of ending on a note of cynicism I cannot help but observe  local history and how for the last 20 years Hertfordshire has split and amalgamated back to a united Hertfordshire again. Now we have two CCGs, a West and an East; I wonder how long before the CCGs merge again.

The last fading phase of the Red House CCG will witness the gravitational accumulation of power to the central black hole and the endless cycle of NHS reorganisation hit just another bureaucratic barrier, whilst we reflect on what could have been and should still be.

Given our record of success, why cannot the Department of Health and the NHS Commissioning Board make an exception and let us survive? Why does conformity and size, rather than performance and vision,  matter so much in the NHS?

Kenneth Spooner was the chair of the Red House CCG


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