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It is quite an honour to have been asked to write this editorial at a time of such momentous change in the NHS.

On 1 April clinical commissioning groups (CCGs) become statutory bodies. In order to achieve that, every CCG has to go through the authorisation process.
As a chair of a CCG, we have recently been through our own authorisation process and panel review. It was like holding a mirror up to ourselves and seeing not only the bad bits and the missing detail, but also the good things we have already achieved.

We tend to dwell on what we are not good at and forget to celebrate our achievements. Every GP must now embrace the challenge for the NHS in the next few years.

People tell me they are not into commissioning and I reply: ‘every act a GP does, every prescription, every referral or non-referral is a commissioning decision.’
I see the authorisation process as similar to a driving test, where you learn the rules of the road from the books but it is only by getting behind the wheel and on the road, that you really discover what is needed.

We still have 25 reds that I am confident we will turn green by April. If we can’t, we will be approved with conditions which is like having to keep an L plate on until the conditions are met.

I for one would not want to accept the responsibility for commissioning hundreds of millions of pounds of healthcare without knowing I was up to the job!
It is great to see how many CCGs are already making decisions and changing the system. This requires good strong leadership and I am pleased to see Dr Amit Bhargava from my neighbouring CCG (Crawley) outline the challenges ahead (p18) .

We both strive for a clinically-led and managerially-enabled health service. The challenges of commissioning high quality healthcare with a finite financial envelope will not go away and there is much talk about how to achieve it.

The announcement of the budgets CCGs will receive reminds me that nobody thinks their budget is right. There are always going to be winners and losers and we just have to accept that fact. The success will be how we make best use of that public pound.

The key is great partnerships. Partnerships between CCGs, the local authority and the private sector. So long as we maintain our focus on the patient and getting the best out of every organisation by co-operating rather than competing, we will succeed. People co-operate, organisations compete.

There needs to be a cultural change in the NHS so there is a seamless journey for our patients. Culture is what you do when no-one is watching.

We know of the need to make savings and the Nicholson challenge to re-invest £20 billion. This can only happen when everyone is determined to set aside their vested interests and deliver the right outcome.

Think tank, The King’s Fund, has called on us to think differently and its overview of future trends makes for sobering reading.

With the unprecedented financial pressures and rising expectations we have to think and then act differently.

We have a real opportunity to engage with the changes and truly forge the health service its founding fathers dreamt of in 1948.

The health and wellbeing boards (HWBs) will be a key player in merging health and social care together so that the real determinants of ill health, housing education and social situations can be addressed as we focus on prevention rather than persist in fixing once the problem has occurred. We should be striving for a health service not an illness one.

As the squeeze on finances starts to bite, with the council funding falling and flat funding for health, tensions in the system will rise and behaviours will undoubtedly change. This is where a strong relationship between partners at the HWB will prove its mettle.

I am told by those longer in the tooth than I, that we have tried all this before but I remind them that the law has changed to make clinicians responsible now and that has never been tried before.

I am optimistic that CCGs will rise to the challenge, show true leadership and deliver real change. For all aspiring leaders, it is okay to put your head above the parapet. When I did, I was expecting to be shot at but had not realised how many times by my own side.

May I wish you a Happy New Year and look forward to meeting 2013 and all it throws at us!


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