This report and the accompanying CCG evaluation survey highlight deep concerns about a loss of clinical leadership and a diminishing influence from primary care.
The timing and the need for this reorganisation have all been questioned. Many CCGs had already begun working in an integrated way and following the extreme and ongoing pressures of the pandemic, system shift of this size does not seem wise. But efforts should be focussed on the future and retaining what’s good.
The nine years that CCGs held the commissioning budget will probably be seen as a halcyon time by primary care leaders in terms of making changes for their populations and raising primary care as a corporate entity, a force to be reckoned with.
There is acknowledgement in some quarters that CCGs have run their course – certainly, where the purchaser-provider split led to conflict and division and the financial incentives were misaligned, which led to a reduction in primary care and an increase in acute care. The pandemic highlighted that collaboration is the way forward – something the best CCGs were already implementing.
ICSs are a continuation of this idea that requires a cultural leap from NHS trusts and community providers to come together for the greater good of the system rather than individual organisations.
However, there are significant concerns that ICBs will see a lurch back to the dominance of the acute sector. The recently published constitutions largely show that representation is skewed towards the acutes. GPs will not be leading the commissioning of local services and while PCNs show great promise, they are not placed to negotiate with large acutes. To mitigate against this, groups of GPs are getting together as boards, alliances or collaboratives working with local medical committees and PCNs to ensure primary care is present as the majority of patient interactions are in primary care.
ICSs have huge potential to build on relationships and support changes at place and neighbourhood level. But national priorities will need to run alongside, rather than eclipse the local ones and funding must be delegated to the front lines for local innovations.
PCNs are the jewel in the crown for primary care and if they can keep practices on side, cope with the demands of the network contract and access good data they can effect change for their populations. This comes with caveats, though – of being supported as leaders and having workforce, finances, estates and time.
And the skills of outgoing clinical leads should be captured. Outgoing CCG leaders could be invited to mentor and advise new leaders. While in many areas tensions may make this unpalatable, the skills of CCG clinical leaders could be harnessed in other ways – perhaps through online coaching or mentoring to other areas of the country.
Succession planning should be continuous to mitigate against the loss of clinical leadership in the future – because nothing is as certain in the NHS as change.
