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Finance issues could challenge viability of five-year plans

Finance issues could challenge viability of five-year plans


Exclusive Clinical commissioning leaders believe that although the five-year strategy imposed by NHS England was important, current funding arrangements leave little scope for change. 

The final deadline for the five-year strategy document, along with a two-year operating plan of how it will work, was today (20 June 2014). 

Clinical commissioning groups (CCGs) were asked to work with providers and local partners to develop a “robust and ambitious” plan which would secure continuous, sustainable healthcare for the local population. 

NHS England guidance said each plan must “drive its decisions to ensure its providers are best placed to deliver high quality and sustainable services for patients”. 

Dr Amit Bhargava, chief clinical officer of Crawley CCG felt that developing the plans was a good process for his CCG, which has led to local commissioners and providers working together to compare objectives. 

Yet problems with the CCG allocation formula, which dictates how much funding each organisation receives, must be “ironed out”. 

He said: “Two years [worth of planned services] gives the government a chance to iron out some of the problems with the formula. 

“Some people have been getting far too much money and some far too little. The chances of getting good healthcare is not equal for citizens across England.” 

Dr Derek Greatorex, clinical chair of South Devon and Torbay CCG, in one of the pioneer areas, said he does not feel that the strategic plans entirely match up with NHS England’s financial plans for CCGs. 

“We need to have financial planning regimes which go beyond the current imperative to achieve a financial balance within a year,” he said. 

“This leaves very little room to initiate more radical change in the system, as many of the outcomes that move resources differently around the system take more than a few months to achieve their financial incentives.” 

Yet Dr Nadim Fazlani, chair of Liverpool clinical commissioning group (CCG) and chair of the NHS Commissioning Assembly’s CCG Development Working Group, disagreed that the allocations will cause an issue. 

He said: “Although we only have two-year budget allocations, we have a good idea of what the allocations will be over the next three years. Of course that might change, but all five-year plans will be subject to change annually at least. 

“And in the absence of five-year plans we would not be able to make strategic decisions.” 

According to NHS Clinical Commissioners president Dr Michael Dixon, current financial issues mean that five-year plans cannot afford to be taken as gospel. 

He said: “I'm afraid the health service has been full of grand strategies over the years which have often gathered dust on shelves because other priorities came along or budgets were overspent. 

“The principle of having a five-year plan is a good one, because you have to know where you're going, but at a time of such financial doubt I think we can't take them as seriously as we might.”  


Dr Nadim Fazlani, said that the process of developing the plans was “very rigid and inflexible”. 

However he felt the process was worthwhile because it allowed the CCG to focus on what they needed to deliver while also providing a benchmark with which to compare themselves to other groups across the country. 

The plans were written according to outcomes prescribed by NHS England. 

He said: “It was time well spent. All CCGs will now have metrics to measure their data by. Without that, it’s possible that we may have chosen outcomes which were different from other CCGs.” 

Dr Greatorex said that although the plans provided “objectives to work towards”, he does not think they should be used as “blueprints”. 

He said: “They really must be regarded as a proposal or an offer which is subject to review – a living document which resides as a fundamental part of our commissioning strategy, not languish on a shelf.” 

However, Dr Bhargava was keen to point out that the five-year strategies could be a chance to talk about CCG plans with other stakeholders such as local councillors and MPs. 

“What we don’t want to happen is for health to become a political football during the election process, and for people to start promising things which are not in our strategy. 

“One of the conversations I’m about to have is with our elected members, so that they’re clear on our strategy – when they go and do their electioneering they can use our current strategy as a way of explaining to people what the health service is going to be like, rather than promising things which we are never going to deliver,” Dr Bhargava said. 


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