Wednesday, 21 September 2011

Clinical Commissioning Groups – reality is beginning to hit home..

Interesting. A survey of half the clinical commissioning groups has noted concerns among the GP leaders regarding budget pressures, the viability of smaller groups and the inheritance of debt.

The NHS Alliance and National Association of Primary Care jointly undertook this survey, following their coming together to represent CCG’s (formerly known as GP Consortia in the first draft of the Health and Social Care Bill)

Dr Michael Dixon, Chair of the NHS Alliance is finally demonstrating some insight that many commentators have been stressing for months. Apparently grudgingly accepting that boards should now include clinicians other than GPs, he acknowledges that ‘CCGs need to reach critical mass’ to mitigate audit expense. Dixon goes on to state ‘There’s a risk of recreating the old system of 150 Primary Care Trusts’  

Taraah !!

This is what we have been saying all along – CCGs will become PCTs by another name. And how much time, money, heartache, redundancy and service disruption will have happened along the way I wonder?

Dixon is not only concerned about the possibility of inheriting debt from PCTs. He also says ‘My GP leaders don’t want to be in the position of decommissioning services’.

This is the same Michael Dixon who, in bullish mood at the NHS Future Forum back in May said ‘GP’s don’t want to be managed – we want to be seduced’

Well Dr Dixon – time to face reality. With power comes responsibility, with change comes responsibility, with relationships (following seduction or not) come responsibility.  The NHS is tasked to produce a 4% efficiency gain year on year for 4 years. Fit for purpose commissioning means looking at treatment regimes, clinical outcomes and service improvements to deliver high quality, cost effective care. This may involve decommissioning of some services to make way for better systems. A good example of this would be the new oral anticoagulant drugs expected to replace warfarin for selected patients. If warfarin is prescribed less, then the ongoing monitoring of this drug, often involving weekly blood tests and dosage adjustment, will be reduced. Some services within specialist centres currently providing this analysis may be decommissioned. The appropriate body to make such a pathway decision would, of course, be the CCGs

Like a naïve new parents with misty eyes looking forward to their little bundles of joy, coming down to earth with the reality of dirty nappies and the challenges of discipline – GP Leaders of CCGs have a tough job ahead.

There are big bucks to be spent – and big bucks to be saved. There are stakeholders to be appeased and voices to be heard. There are pathways to be considered and local needs acknowledged. All this alongside the day to day priorities of providing tip top primary care to their patients.

Little wonder that, according to a recent survey by the British Medical Association more than half of GPs are expected to retire over the next two years.

Who could blame them?


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