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Teething pains: CCGs one month in

Teething pains: CCGs one month in

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CCGs have been in charge for a month and as predicted changes at patient level are not discernable…yet. But that’s not to say that changes aren’t being made.  

There were fears that clinical commissioning groups would not be big enough to make changes in secondary care, but we’re hearing that by refusing to sign off inherited primary care trust (PCT) contracts with acute trusts,  the situation is coming to a head - changes will have to be made. 

At this point there seems to be a stand-off in some areas with hospitals unhappy that their financial plans will be impacted by a change in business from primary care. This was one of the things the reforms promised – to give clinicians the power to re-shape services. Whether these changes will be large enough to impact on overall NHS costs remains to be seen.

CCGs are also reporting difficulty with the handover notes from PCTs where existing contract details are scant. This is certainly adding to the pressure on leading clinicians, who are now accountable for so much more than the patient in front of them. 

As holder of the GP contract, NHS England is responsible for performance management - which is turning out to be another area of concern.  CCGs have a role in monitoring the quality of their member practices., but if one practice continues to over-prescribe and over-refer it puts financial pressure on CCGs and could impact on the quality premium reward.

Peer pressure can only go so far. In some cases more drastic action will need to be taken. But who does this and how it’s going to be done is still unclear. 

And this is something that local health and wellbeing board councilors feel is a problem. They’ve cited poorly performing schools as an example where immediate action is taken to change the leadership team or close the school - the same cannot be said of the NHS which is much slower to react.

Lastly, with all these new organisations coming into being there are concerns about who is in charge. When the measles vaccination plan was announced by the Department of Health, Public Health England may have been consulted, but frontline clinicians, who have to deliver these vaccinations were not!  

Where was the clinical leadership there? 

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